Can bladder stones be removed during prostate surgery?

Yes. In many men, bladder stones can be removed during the same procedure as prostate surgery, particularly when bladder stones have developed because of obstruction from an enlarged prostate. Performing both procedures together can treat the stone as well as the underlying cause of poor bladder emptying. The EAU Guidelines report that combined bladder stone and prostate procedures can generally be performed safely, although some short-term risks such as urinary tract infection or temporary incontinence may be slightly higher.

Bladder stones and enlarged prostate are often connected in older men.

An enlarged prostate can narrow the urinary passage and make it difficult to empty the bladder completely. Persistent residual urine can contribute to bladder stone formation.

When both conditions are present, your urologist may consider treating them during the same operation.

Why might both procedures be performed together?

If the bladder stone is removed but significant prostate obstruction remains, the underlying problem may continue.

Treating the prostate obstruction at the same time can:

• Improve urine flow.
• Reduce bladder outlet obstruction.
• Improve bladder emptying.
• Address an important cause of bladder stone formation.
• Potentially reduce the risk of future bladder stones.

The EAU identifies bladder outlet obstruction from benign prostatic obstruction as the most common predisposing factor for bladder stones in adults.

How are the bladder stones removed during prostate surgery?

The exact technique depends on the stone and the prostate procedure being performed.

A urologist may use transurethral cystolithotripsy/cystolitholapaxy to break the bladder stone into smaller fragments and remove them.

The prostate can then be treated during the same surgical session using an appropriate procedure, such as TURP or laser prostate surgery, depending on the patient's prostate size, anatomy, symptoms and other clinical factors.

Can bladder stones be removed during TURP?

Yes. Bladder stone removal can be performed alongside transurethral resection of the prostate (TURP) when clinically appropriate.

Evidence reviewed by the EAU indicates that simultaneous treatment of bladder stones and benign prostatic obstruction does not appear to significantly increase major postoperative complications compared with prostate surgery alone.

Can bladder stones be removed during HoLEP?

Yes. Bladder stone treatment can also be performed during Holmium Laser Enucleation of the Prostate (HoLEP) when appropriate.

Studies reviewed in the EAU Guidelines found no significant difference in overall complication frequency in larger cohorts undergoing HoLEP with or without simultaneous bladder stone treatment, although some studies reported increased short-term urinary incontinence or UTI risk.

Is combined surgery better than treating the conditions separately?

There is no single approach that is best for every patient.

The decision depends on:

• Size and number of bladder stones.
• Severity of prostate obstruction.
• Prostate size and anatomy.
• Amount of residual urine.
• Bladder function.
• Urinary infection.
• Overall health.
• The planned prostate procedure.

For some patients, treating both problems in one session is practical and appropriate. In others, staged treatment may be preferable.

Does removing the prostate obstruction prevent bladder stones from returning?

Treating prostate obstruction can address an important underlying cause, but it does not guarantee that bladder stones will never recur.

Other factors, such as bladder dysfunction, urethral stricture, recurrent infection or other urinary abnormalities, can also contribute to stone formation.

Therefore, the cause of the bladder stone should be evaluated rather than assuming that prostate enlargement is always the only reason.

Are There Additional Risks With Combined Surgery?

Combined procedures can have some additional considerations.

The EAU reports that major complication rates are generally not significantly different when bladder stones are treated alongside benign prostatic obstruction. However, short-term urinary tract infections and temporary postoperative incontinence may occur somewhat more frequently in some patient groups.

Your urologist will assess whether the benefits of treating both conditions together outweigh the individual risks.

Who May Benefit From Combined Treatment?

Combined treatment may be considered when a patient has:

• Symptomatic bladder stones.
• Significant prostate obstruction.
• High residual urine.
• Recurrent bladder stones associated with BPH.
• Urinary retention or other complications related to prostate obstruction.

The decision should be based on the patient's complete urinary evaluation.

SCI International Hospital

At SCI International Hospital, New Delhi, Dr. Gautam Banga evaluates patients who have both bladder stones and enlarged prostate to determine whether both conditions can appropriately be treated during the same surgical session.

Depending on the patient's prostate size, stone characteristics, urinary obstruction and overall health, an appropriate combination of endoscopic bladder stone removal and advanced prostate surgery may be considered.

The objective is to treat the existing stone while also addressing the prostate-related obstruction that may have contributed to its formation.