Bladder Stone Surgery

Introduction

If you have been told you have bladder stones, you are probably weighing what comes next. Small stones sometimes pass on their own, but stones that cause pain, bleeding, infections, or trouble urinating usually need to be removed. Bladder stone surgery is the procedure used to take them out.

For most people, the operation is done through a thin scope passed up the urethra (the tube urine flows through), with no cuts on the outside of the body. Laser energy is used to break the stones into small pieces, which are then washed or suctioned out. Recovery is usually quick, and symptoms often improve straight away.

This guide explains the different types of bladder stone surgery, who they suit, how to prepare, what happens on the day, what recovery looks like, the risks involved, and how to lower the chance of stones coming back. Because bladder stones almost always form for a reason — usually a problem that stops the bladder emptying fully — treating the underlying cause is just as important as removing the stones themselves.

What Is Bladder Stone Surgery?

Bladder stone surgery is any procedure that removes these stones. The most common form is called cystolitholapaxy, which simply means “crushing and removing a bladder stone.” In a cystolitholapaxy, a narrow camera tube called a cystoscope is passed up the urethra into the bladder. The surgeon sees the stone directly through the scope and uses a laser fibre or another energy source to break it into small fragments that can be washed out.

When stones are very large, very hard, or when the bladder anatomy makes scope access difficult, other approaches may be used — including a small incision above the pubic bone or, occasionally, an open operation. The shared aim is the same: clear the stones, relieve the symptoms, and address whatever caused the stones to form in the first place.

Why Is Bladder Stone Surgery Performed?

Surgery is usually advised when bladder stones are causing problems or are unlikely to clear on their own. Common reasons doctors recommend removal include:

• Pain in the lower abdomen or during urination
• Blood in the urine, either visible or detected on testing
• Recurrent urinary tract infections caused or worsened by the stone
• Urinary obstruction — a stone blocking urine flow, sometimes causing a sudden inability to urinate
• Stones that are too large to pass naturally through the urethra
• Damage to the bladder lining from a stone rubbing against it
• Risk to the kidneys if back-pressure from a blocked bladder is affecting kidney drainage

Even when a bladder stone is not causing severe symptoms today, urologists often advise removal because stones tend to grow over time and can lead to infection, bleeding, or blockage later. Stones can also irritate the bladder lining in ways that, very rarely, raise the risk of long-term changes.

Who Is a Candidate?

Most adults with a bladder stone large enough to cause symptoms are candidates for endoscopic (scope-based) surgery. Your urologist will consider:

• The size and number of stones. Small to medium stones suit endoscopic laser removal. Very large stones, or many stones together, may need a different approach.
• The hardness of the stone. Some stones break up easily with laser; very dense stones may take longer or need additional energy.
• The underlying cause. If an enlarged prostate, a urethral narrowing, or a neurogenic bladder is responsible, this often needs to be treated in the same operation or shortly after.
• The condition of the urethra. In men, a very tight urethra or stricture may make scope passage difficult.
• General health and fitness for anaesthesia. Endoscopic surgery is usually well tolerated even in older adults.

Children, people with severe spinal cord injury, and patients with very large or stuck stones may be managed differently — covered in later sections of this article.

Alternatives to Surgery

Surgery is the standard treatment for most symptomatic bladder stones, but a few situations call for non-surgical management or for treating the cause first.

Watchful Waiting and Hydration

Very small stones (a few millimetres) found incidentally on a scan, with no symptoms, may sometimes be observed. Drinking enough water can help small fragments pass. This approach is uncommon for true bladder stones because they rarely shrink on their own once formed — but it may be considered in selected cases.

Treating the Underlying Obstruction First

In men, the most common cause of bladder stones is benign prostatic hyperplasia (BPH), or an enlarged prostate, which stops the bladder emptying fully. In some plans, the prostate is treated — with medication or with a separate prostate procedure such as TURP (transurethral resection of the prostate) — either before, during, or shortly after stone removal. Treating the obstruction is what stops new stones forming.

Shock Wave Lithotripsy (ESWL)

Shock wave lithotripsy uses sound waves from outside the body to break stones into fragments. It is widely used for kidney stones but is less commonly used for bladder stones, because direct endoscopic access through the urethra is usually faster, more complete, and avoids the need for the patient to pass fragments through a partially obstructed bladder. Your urologist will explain when, if ever, this is a reasonable option for you.

Catheterisation Alone

In frail patients who are not fit for any anaesthesia, occasionally only catheter management is offered to relieve symptoms. This does not remove the stones and is not a long-term solution.

For most people with symptomatic bladder stones, removing them surgically is the treatment doctors recommend, and the alternatives above apply to a minority of cases.

Surgical Approaches

Several approaches exist for bladder stone surgery. The choice depends mainly on stone size, stone number, the patient’s anatomy, and what other procedures may be needed at the same time.

Transurethral Cystolitholapaxy (Endoscopic Laser Surgery)

This is the most common bladder stone surgery in adults today. A rigid or flexible cystoscope is passed up the urethra into the bladder. A laser fibre (most often a holmium laser) is then advanced through the scope and used to fragment the stone under direct vision. The pieces are flushed or suctioned out through the scope.

Key features:

• No external incision
• Usually done under spinal or general anaesthesia
• Typical operating time 30 to 90 minutes, depending on stone size
• Hospital stay often one night, sometimes day-case
• Catheter usually placed for one or two days

For most patients with stones up to a few centimetres, this is the approach urologists turn to first.

Percutaneous Suprapubic Cystolitholapaxy

For very large stones, multiple large stones, or situations where the urethra is too narrow to pass enough equipment (for example, in some children, or in men with a urethral stricture), the surgeon may go through a small incision just above the pubic bone, directly into the bladder. A scope is passed through this tract and the stones are broken and removed.

This approach takes longer to heal than the transurethral route because of the small abdominal wound and the bladder wall repair, but it allows faster removal of bulky stone material.

Open Cystolithotomy

Open bladder stone surgery involves a cut in the lower abdomen, opening the bladder, and removing the stones whole. It is now used in only a small number of situations — for example, very large stones that cannot reasonably be broken up endoscopically, certain bladder abnormalities such as a large diverticulum (pouch) holding the stone, or when an open prostate operation is being done at the same time. Recovery is longer than for endoscopic methods, with a hospital stay of several days and a urinary catheter in place for a week or more.

Robotic and Laparoscopic Surgery

Robotic or laparoscopic (keyhole) surgery is occasionally used in complex cases, especially when a bladder diverticulum is being removed along with the stones inside it, or when stone removal is combined with another reconstructive operation. It is not routinely needed for straightforward bladder stones.

Choosing Between Approaches

For most adults with a moderate-sized bladder stone and an enlarged prostate, the typical plan is transurethral laser cystolitholapaxy, often combined with a prostate procedure in the same anaesthetic. Larger or more complex situations may shift the plan toward a percutaneous or, rarely, an open approach. The decision is made by your urologist after reviewing your imaging and your overall health.

Preparing for Bladder Stone Surgery

Once the decision to operate has been made, you will go through a short period of preparation. The exact steps vary by hospital, but typically include:

Pre-Operative Assessment

• Blood tests to check kidney function, blood counts, and clotting
• Urine tests and culture to detect any infection that needs treatment before surgery
• Imaging review — ultrasound, X-ray (KUB), or CT scan to confirm stone size and position
• Cystoscopy in selected cases, to look inside the bladder beforehand
• Anaesthetic review to confirm whether spinal or general anaesthesia is most suitable for you
• Heart and chest checks if you have other medical conditions

Treating Infection First

Operating on an infected bladder carries a higher risk of complications, especially sepsis (a serious whole-body reaction to infection). If your urine shows infection, antibiotics will usually be given before surgery, and the operation may be delayed by a few days to allow the infection to clear.

Medication Adjustments

Tell your team about every medication you take. Blood-thinning drugs — including aspirin, clopidogrel, warfarin, and the newer anticoagulants — often need to be paused for a few days before surgery, but only on your doctor’s instructions. Diabetes medication, blood pressure medication, and inhalers will usually be discussed individually.

Fasting and Final Preparation

You will normally be asked not to eat for around six hours and not to drink for around two hours before the procedure, although your team will give you exact times. You will sign a consent form after the surgeon explains the procedure, its benefits, and its risks.

What Happens During Bladder Stone Surgery

The following describes a typical transurethral laser cystolitholapaxy, the most common form of bladder stone surgery.

1. Anaesthesia. You receive either a spinal anaesthetic (which numbs you from the waist down while you remain awake) or a general anaesthetic (in which you are asleep). The choice depends on your health, your preference, and your anaesthetist’s advice.
2. Positioning. You lie on your back with your legs supported in stirrups.
3. Insertion of the cystoscope. A thin scope is gently passed through the urethra into the bladder. Sterile fluid is run into the bladder to give the surgeon a clear view.
4. Inspection. The surgeon examines the bladder lining, the stones, and the openings of the ureters (the tubes from the kidneys). The prostate and urethra are also assessed in men.
5. Stone fragmentation. A laser fibre is passed through the scope and used to break the stone into small pieces. Other energy sources, such as a mechanical lithotrite or ultrasonic probe, may be used in some centres.
6. Removal of fragments. The pieces are flushed out with fluid or removed using small graspers passed through the scope.
7. Treatment of the underlying cause, if planned. If a prostate procedure has been agreed in advance, it is usually done in the same operation.
8. Catheter placement. A urinary catheter is usually placed at the end of the procedure to drain urine and any small blood clots while the bladder heals.

The whole procedure typically takes between 30 and 90 minutes, depending on stone size and whether other procedures are added.

Recovery and Healing

Recovery from endoscopic bladder stone surgery is usually faster than recovery from most abdominal operations because there is no external wound.

The First Day

You will wake up with a urinary catheter in place. The urine in the bag often looks pink or red at first because of minor bleeding from the bladder lining; this usually clears over a day or two. You will be encouraged to drink fluids and to walk gently. Most people are able to eat normally within a few hours.

Hospital Stay

For straightforward endoscopic surgery, most patients stay one night, although some centres perform it as a day case. Longer stays are usual for percutaneous or open approaches, or when other procedures (such as prostate surgery) have been added.

The Catheter

The catheter is usually removed after one or two days, once the urine is clear. After it is taken out, the first few times you pass urine may sting or feel urgent. This usually settles within a day or two.

The First Two Weeks

At home, you can expect:

• Mild burning during urination for a few days
• A pink tinge to the urine on and off for a week or so
• Going to the toilet more often than usual at first
• Mild lower abdominal discomfort, usually controlled with simple painkillers

You will normally be advised to drink plenty of water, avoid heavy lifting and strenuous exercise for one to two weeks, and avoid sexual activity for a short period as advised by your surgeon.

Return to Normal Activities

What Is Not Normal

Contact your medical team if you develop:

• Heavy bleeding or clots blocking urine flow
• Fever or shaking chills
• Severe pain that is not relieved by your prescribed painkillers
• Inability to pass urine after the catheter has been removed
• Cloudy, foul-smelling urine with increasing pain

These can be signs of infection, retention, or bleeding that need prompt review.

Risks and Complications

Bladder stone surgery is generally safe, but, like any procedure, it carries some risks. Knowing what they are helps you make an informed decision and recognise problems early if they happen.

Common, Usually Minor

• Burning during urination for a few days
• Blood in the urine for a week or two
• Urinary frequency and urgency as the bladder settles
• Mild lower abdominal discomfort

Less Common but Important

• Urinary tract infection, sometimes requiring antibiotics
• Difficulty urinating after the catheter is removed, occasionally needing the catheter to be replaced for a short period
• Bleeding heavy enough to require medical attention; clots may need to be washed out
• Injury to the urethra, which may rarely lead to a stricture (narrowing) months or years later
• Bladder wall injury or perforation — rare; may need a catheter for longer or, very rarely, repair

Rare but Serious

• Sepsis — a severe response to infection, more likely if there was untreated infection before surgery
• Reactions to anaesthesia
• Need to convert to a different surgical approach if endoscopic removal is not complete

Recurrence

Most people feel a clear improvement in symptoms soon after recovery: less pain, less bleeding, fewer infections, and a stronger urine flow if an obstruction was treated at the same time.

Follow-Up

Your urologist will usually see you within a few weeks of surgery to check how you are doing. Follow-up often includes:

• A urine test to check for infection
• An ultrasound or X-ray to confirm the bladder is empty of stones and is emptying properly
• A review of any prostate or bladder treatment plan
• For men, ongoing prostate monitoring if BPH was the underlying cause

Preventing Recurrence

Because bladder stones almost always form because urine is sitting in the bladder, prevention focuses on improving bladder emptying and reducing crystal formation. Common steps doctors recommend include:

• Drinking enough water to keep the urine pale — usually around 2 to 3 litres a day for most adults, unless your doctor has told you to limit fluids for another condition
• Treating prostate enlargement with medication or surgery, as advised
• Managing neurogenic bladder with timed voiding, intermittent catheterisation, or other strategies guided by a urologist
• Treating any urinary infections promptly
• Looking after long-term catheters properly, including regular changes and good hygiene
• Managing diabetes and other conditions that affect bladder function

If you have had several stones, your urologist may ask for stone analysis (testing the stone fragments in a lab) and blood or urine tests to look for metabolic causes such as high uric acid. Diet adjustments are sometimes recommended based on the type of stone.

When to Get Checked Again

Even with good prevention, watch for the symptoms that brought you to surgery in the first place — pain, blood in urine, frequency, urgency, recurrent infections, or a weak stream. Early review allows small stones to be picked up before they grow.

Bladder Stones and Surgery in Children

Bladder stones are uncommon in children in high-income countries today but remain a notable problem in parts of the world where they are linked to diet, dehydration, and recurrent infection in early childhood. They also occur in children with:

• Spina bifida or other causes of neurogenic bladder
• Bladder reconstruction using a piece of bowel
• Long-term catheter use
• Foreign bodies in the bladder

The principles of treatment are similar to those in adults, but with some differences:

• Children’s urethras are narrower, so percutaneous (above the pubic bone) approaches may be used more often than transurethral ones.
• General anaesthesia is almost always used.
• Reconstructive or congenital problems often need to be addressed at the same time, by a paediatric urologist.
• Nutritional review and hydration education are an important part of preventing further stones, especially in younger children.

If your child has been diagnosed with a bladder stone, care is usually led by a paediatric urology team. The plan will be tailored to the child’s age, the cause of the stone, and any underlying bladder problem.

Frequently Asked Questions

Is bladder stone surgery painful?

You will not feel pain during the surgery itself because of the anaesthetic. Afterwards, most people describe mild discomfort, burning when passing urine for a few days, and a feeling of needing to urinate often. Simple painkillers usually manage this well.

How long does the operation take?

A typical transurethral laser cystolitholapaxy takes between 30 and 90 minutes, depending on stone size and whether other procedures (such as treatment for an enlarged prostate) are done at the same time.

How long will I stay in hospital?

Endoscopic bladder stone surgery often involves a one-night stay, and sometimes is done as a day case. Open or percutaneous surgery usually requires several days in hospital.

Will I need a catheter after surgery?

Yes, in most cases. A catheter is placed during the operation and removed once the urine is clear, typically after one or two days for endoscopic surgery and longer for open procedures.

How soon can I go back to work?

Most people doing desk-type work return within a week after endoscopic surgery. Heavy physical work, lifting, and strenuous exercise are usually avoided for two to four weeks. Recovery from open or percutaneous surgery takes longer.

Can bladder stones come back after surgery?

Yes, they can, particularly if the reason the stones formed — usually a problem with bladder emptying — is not treated. Treating the underlying cause, drinking enough water, and following up with your urologist are the main ways to lower the chance of recurrence.

Will the surgery affect my ability to urinate normally afterwards?

In most cases, urination improves after surgery because the stone (and often the obstruction behind it) has been treated. Some short-term burning, urgency, and frequency are common in the first few days and usually settle within a week or two.

Can bladder stones be treated with medication alone?

True bladder stones rarely dissolve with medication. Some very small fragments may pass with hydration, and medication can help treat the underlying cause (for example, drugs for prostate enlargement). For stones that are causing symptoms or are too large to pass, removal is the standard approach.

Is laser surgery safe for the bladder?

Holmium and similar lasers used in bladder stone surgery have been used widely for many years and are considered safe in trained hands. They allow the surgeon to break stones precisely while protecting the surrounding bladder tissue.

Will the surgery affect sexual function?

Bladder stone surgery itself does not usually affect sexual function. If a prostate procedure is done at the same time, it can have some effects (such as changes in ejaculation), which your surgeon will explain in advance.

Conclusion

Bladder stone surgery is a well-established treatment with a clear goal: clear the stones, settle the symptoms, and protect the bladder and kidneys. For most adults, this is achieved through endoscopic laser surgery, with a short hospital stay and a recovery measured in days to a few weeks. Larger or more complex stones may need a percutaneous or open approach, and children with bladder stones are managed by paediatric urology teams.

The most important part of long-term success is not the surgery itself but what happens afterwards. Because bladder stones almost always form because the bladder is not emptying properly, treating that underlying cause — whether an enlarged prostate, a neurogenic bladder, an infection, or a long-term catheter situation — is what prevents the problem from coming back. With good follow-up, good hydration, and treatment of the underlying cause, most people return to comfortable, normal urinary function after surgery.