Guideline sources The following summarized guidelines for the evaluation and management of bladder stones are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2020). 1 Guidelines 1. Diagnostic investigations Initial evaluation: obtain ultrasound as first-line imaging in patients with symptoms suggestive of a bladder stone. A Show 4 more 2. Medical management https://web.pathway.md/diseases/recbwiiE3D61W3LzU 1/3 6/29/23, 3:18 AM Bladder stones Pathway Oral chemolysis: offer oral chemolysis in adult patients with radiolucent or known uric acid bladder stones. B 3. Therapeutic procedures Transurethral cystolithotripsy: Offer transurethral cystolithotripsy in adult patients with bladder stones, where possible. A Perform transurethral cystolithotripsy with a continuous flow instrument (such as nephroscope or resectoscope) in adult patients, where possible. B Percutaneous cystolithotripsy: offer percutaneous cystolithotripsy if transurethral cystolithotripsy is not possible or advisable. A Shock wave lithotripsy: consider offering open, laparoscopic, and extracorporeal shock wave lithotripsy as alternative treatments in adult patients, if endoscopic treatment is not advisable. C Procedures for bladder outlet obstruction: perform procedures for the stone and underlying bladder outlet obstruction simultaneously, where possible, in adult patients with bladder stones secondary to bladder outlet obstruction. A 4. Surgical interventions Surgical stone removal: consider offering open cystolithotomy as an option in adult patients with very large bladder stones. C 5. Specific circumstances Pediatric patients: offer transurethral cystolithotripsy in pediatric patients with bladder stones, where possible. B Show 4 more 6. Preventative measures Prevention of stone recurrence: offer regular irrigation therapy with saline solution to reduce the risk of stone recurrence in adult and pediatric patients with bladder augmentation, continent cutaneous urinary reservoir or neuropathic bladder dysfunction and no history of autonomic dysreflexia. B 7. Follow-up and surveillance Serial imaging assessment: individualize follow-up imaging for each patient. Recogne that factors affecting follow-up include whether the underlying functional predisposition to stone formation can https://web.pathway.md/diseases/recbwiiE3D61W3LzU 2/3 6/29/23, 3:18 AM Bladder stones Pathway be treated (such as transurethral resection of prostate) and metabolic risk. B Clinical findings Symptoms Past medical history Dysuria Benign prostatic hyperplasia Feeling of incomplete bladder emptying Bladder outlet obstruction Kidney stones Hematuria Imaging findings Penile pain Scrotal pain Bladder stones Sudden voiding stoppage Suprapubic pain Urinary retention Weak urine stream Abdominal exam Bladder distension References 1. Thomas Hughes, Hui Ching Ho, Amelia Pietropaolo et al. EAU Guidelines on Bladder Stones. Turk J Urol. 2020 Nov; 46 Suppl 1 S104 S112. Open 2. Stephen W. Leslie, Hussain Sajjad, Patrick B. Murphy. Bladder Stones. In: StatPearls Internet]. Treasure Island FL StatPearls Publishing; 2020 Jan. 2020 Jun 12. Open 3. F T Hammad, M Kaya, E Kazim. Bladder calculi: did the clinical picture change?. Urology. 2006 Jun;67 6 1154 8. Open https://web.pathway.md/diseases/recbwiiE3D61W3LzU 3/3