Treatment of a Radio-Opaque Bladder Stone on X-Ray in an Adult
This protocol covers the management of a bladder stone confirmed as radio-opaque on plain X-ray in an adult patient — where the stone is not radiolucent and is not a known uric acid stone.
Clinical Scenario
An adult presents with a bladder stone that is visible on plain X-ray as radio-opaque. The stone's opacity on imaging distinguishes this presentation from radiolucent stones and known uric acid stones, and this characteristic can guide both the choice of intervention and subsequent follow-up.
Treatment Approach
Guideline-supported management centres on an endoscopic surgical approach — with a transurethral route offered as the primary option. Alternative procedural approaches exist for cases where the initial route is not possible or advisable, with further options for atypical presentations. The complete protocol details the specific techniques, the conditions governing each option, and when to escalate.
Treatment goal: Stone-free status.
References
- Offer adults with bladder stones transurethral cystolithotripsy where possible.
- However, plain X-ray provides information on radio-opacity which may guide treatment and follow-up.
- Perform transurethral cystolithotripsy with a continuous flow instrument in adults (e.g., nephroscope or resectoscope) where possible.
- Offer adults percutaneous cystolithotripsy where transurethral cystolithotripsy is not possible or advisable.
- Suggest open cystolithotomy as an option for very large bladder stones in adults and children.
- Open, laparoscopic, and extracorporeal shock wave lithotripsy are alternative treatments where endoscopic treatment is not advisable in adults and children.
- In both adults and children, transurethral cystolithotripsy provides high SFRs and appears to be safe, with a very low-risk of unplanned procedures and major post-operative and late complications.
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