In the prior two columns I shared my personal experience with the common aging male diagnosis of BPH, benign prostatic hyperplasia. A common sideline condition of BPH that results from improper emptying of the bladder is the formation of stones, or calculi, in the lower part of the bladder where residual urine collects. Over time, that collected urine becomes “stagnant,” for lack of a better term, and the minerals that make up urine begin to settle out of solution and form solid masses in the bladder that over time will grow larger and become symptomatic.
Bladder stones can form for different reasons, including surgical procedures called bladder augmentation surgery to improve bladder capacity and function. A bladder diverticulum is a pocket of tissue in the bladder wall that can harbor collected urine and become the incubator for a stone. Simple dehydration is a frequent problem for many people, and lack of water or other fluid intake increases the likelihood of stone formation.
(Experts say that water is best, and I buy distilled, deionized, reverse osmosis-treated water at a local kiosk rather than drinking city tap water. My morning coffee is made with city water, but throughout the day I’m really working hard at keeping a water bottle of the good stuff at my desk and when I am at the gym. I often add some lemon or lime juice to increase the acidity just a tad, too. But I still like plain ole Gatorade fruit punch flavor after a long bike ride or hike.)
A stone that forms in the kidney and passes, hopefully uneventfully, through the ureter into the bladder and takes up residence there becomes a “bladder” stone, and a neurogenic bladder resulting from nerve damage secondary to a spinal cord injury can be a precursor to bladder stone formation.
In my case, I treated symptoms conservatively for many years with meds, so those deposits were slower to grow to the point of becoming symptomatic. As the BPH symptoms increased with the continued slow “hypertrophy” of the prostate, the single stone in my bladder was getting larger too. After a long hike in the state park, I would pass some very dark red bloody urine that cleared up quickly after a couple of urinations. Riding my bike, though, was a different story, and with the stone just bouncing around in my bladder, it made riding for more than a few minutes just too uncomfortable. And of course, dark red blood on urination. All those signs and symptoms, plus the need for self-catheterization for the last couple of months before my TURP, resolved immediately after the surgery in mid-April.
My post-op follow-up was just in early August and the first time I had a chance to catch up with my urologist to get some questions answered. He said an average prostate that is resected by TURP is about 30-50 grams. Mine was over 90 grams. The bladder stone that was broken up (cystolitholapaxy is the clinical term for the procedure) was about 3 cm and was made up of the usual suspects for renal or bladder stone, minerals such as calcium oxalate and struvite that is magnesium ammonium phosphate.
The good news is that TURP for most men is a “one and done” curative procedure for BPH, and without the prostate issue, the bladder stone issue goes away, too. And, without having to wake up 4-5 times a night, my sleep recovery has improved, and I feel rested every morning!
As always, be safe up there, and if you have any questions about medical certification, don’t delay in giving us a call!
