Bladder stone removal (cystolitholapaxy)
A scope is passed through the urethra into the bladder, the stone is broken into small pieces, usually with a laser, and the pieces are washed out. It is often combined with treating what caused the stone, most often an enlarged prostate.
Also called cystolitholapaxy, transurethral cystolitholapaxy, cystolithotripsy, laser cystolithotripsy, litholapaxy, bladder stone laser, bladder stone surgery, stone in my bladder
- Where
- Hospital or outpatient surgery center operating room
- Anesthesia
- General anesthesia or spinal anesthesia
- Time in the room
- 30 to 90 minutes; longer if the prostate is treated too
- Hospital stay
- Same day for stone removal alone; often 1 night if the prostate is treated
- Going home with
- Sometimes a urinary catheter for 1 to 3 days, longer if the prostate is treated
- Back to normal
- A few days for stone removal alone; 2 to 4 weeks with prostate surgery
- Back to work
- A few days for stone removal alone; 1 to 3 weeks with prostate surgery
Overview
Bladder stones are hard lumps of minerals that form inside the bladder, usually because urine sits there too long. In adults, the most common cause is an enlarged prostate that keeps the bladder from emptying fully. Other causes include a narrowed urethra (the tube that carries urine out), nerve problems that affect the bladder, long-term catheters, and stitches or mesh from earlier surgery. Sometimes a small kidney stone drops into the bladder and grows there.
Cystolitholapaxy is the usual way to remove bladder stones. A scope is passed through the urethra into the bladder, the stone is broken into small pieces, most often with a holmium laser, and the pieces are washed out. There is no cut on the skin. Guidelines recommend this approach first for most adults.
Removing the stone is only half the job. If the reason the bladder does not empty is left untreated, stones often come back. In men with an enlarged prostate, the prostate is often treated in the same operation, for example with TURP or laser enucleation (HoLEP). AUA guidelines list bladder stones caused by an enlarged prostate as a reason to offer prostate surgery.
Very large stones, or a urethra too narrow for a scope, may be removed through a small opening in the lower belly (percutaneous) or with open or robotic surgery.
The parts of your body involved
The bladder is a muscular bag low in the pelvis, behind the pubic bone. It stores urine and squeezes to empty it through the bladder neck and the urethra. In men, the urethra passes through the prostate just below the bladder. When the prostate enlarges, or the urethra narrows, the bladder has to push harder and often leaves urine behind. Over years the bladder wall thickens into ridges (trabeculation). Minerals in the urine that is left behind form crystals that grow into stones. The stones roll on the bladder floor and can block the outlet like a ball in a drain, stopping the stream mid-flow.
- Bladder
Stores urine and squeezes to empty. Stones sit on its floor.
- Bladder neck
The outlet where the bladder joins the urethra. A stone can roll into it and stop the stream.
- Prostate
In men, a gland just below the bladder that surrounds the urethra. When it enlarges, the bladder may not empty fully.
- Urethra
The tube from the bladder to the outside. The scope passes through it.
- Bladder wall
Becomes thick and ridged after years of pushing against a blockage. Small pockets (diverticula) can form and trap urine.
Why it’s done
Bladder stones rarely go away on their own and often cause symptoms. Removing them brings relief, and the same operation is often the right moment to fix the cause.
- Pain and a stream that stops
Pain at the end of urination, often felt low in the belly or at the tip of the penis, and a stream that suddenly stops when the stone blocks the outlet.
- Blood in the urine
The stone rubs the bladder lining and can cause visible blood.
- Repeated urinary infections
Stones hold bacteria that antibiotics cannot clear while the stone is there.
- Trouble emptying
Stones together with an enlarged prostate can lead to a bladder that cannot empty at all, called urinary retention.
- Stones seen on a scan
Even without symptoms, many urologists recommend removing bladder stones because they tend to grow and cause trouble.
Other options
- Medicine to dissolve uric acid stones
If the stone is made of uric acid, potassium citrate or a similar medicine can make the urine less acidic and may dissolve it over weeks to months. It does not work for other stone types, and the cause still needs attention.
- Through a small opening in the lower belly
Percutaneous cystolitholapaxy reaches the bladder through a small cut above the pubic bone. It is useful for very large stones, when the urethra is too narrow, or after some urinary reconstructions.
- Open or robotic surgery
Opening the bladder to lift out a very large stone. It is often combined with removing a very large prostate in the same operation.
- Shock wave lithotripsy
Occasionally used for small bladder stones in people who cannot have anesthesia, but it is less effective than breaking the stone through a scope.
- Treating the prostate only
Prostate treatment alone does not remove the stone, but it is often done in the same operation as stone removal.
Getting ready
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Weeks before
The week before
The day before
The morning of
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep and getting positioned
You are put to sleep with general anesthesia, or numbed from the waist down with a spinal. Your legs are raised into padded stirrups so the surgeon can reach the urethra.
After the operation
Right afterward
- Waking up
You wake in the recovery room. Burning or a strong urge to urinate is common, especially with a catheter.
- Bladder spasms
The bladder may cramp around the catheter. Medicines can calm these spasms.
- Washing the bladder
After prostate treatment, salt water may run in and out through the catheter overnight to keep clots from forming.
- Blood in the urine
Pink or red urine is expected and lightens over a few days.
- Catheter out
When the catheter comes out, you are asked to urinate before going home, and a bladder scan may check how well you empty.
- Going home
Usually the same day for stone removal alone, and after one night for most people who also had prostate treatment.
At home
- If you go home with a catheter
Keep the bag below your bladder, empty it when half full, and wash around the catheter with soap and water daily. A leg bag in the day and a larger bag at night is common.
- Burning and urgency
Burning, urgency and frequent urination are common for days to a few weeks, longer after prostate treatment. They ease steadily.
- Blood in the urine
Pink urine comes and goes. After prostate treatment, a brief return of bleeding around 1 to 3 weeks is common as scabs come off. Drink more and rest. Thick clots or trouble urinating need a call.
- Drink plenty
Drink enough to keep urine pale, for most people about 2 to 2.5 liters a day, unless a doctor has limited your fluids.
- Bowels
Avoid straining on the toilet, which can restart bleeding. Use a stool softener, especially while taking opioid pain medicine.
- Activity and lifting
After stone removal alone, most people are back to normal activity within a few days. If the prostate was treated, avoid heavy lifting, straining and vigorous exercise for about 2 to 4 weeks, as your surgeon advises.
- Driving
Not for 24 hours after anesthesia, while taking opioid pain medicine, or while you have a catheter if it makes you uncomfortable.
- Sex
After stone removal alone, when you feel comfortable, usually within a week. After prostate treatment, usually wait 2 to 4 weeks. Many men have little or no fluid with orgasm after prostate surgery, because semen goes back into the bladder.
- Preventing new stones
Empty your bladder fully: urinate, wait a moment, then try again (double voiding). Treat urine infections promptly. Drink steadily through the day. If you use a catheter, follow your catheter care plan closely. For uric acid stones, eating less meat and taking potassium citrate may be advised.
Recovery timeline
- Day 0Stone removed
Home the same day after stone removal alone, or one night with a catheter if the prostate was treated.
- Days 1 to 3Catheter out
Most catheters come out within 1 to 3 days. Burning and frequent urination are expected.
- Week 1Settling
Urine clears, and the stream is often stronger, especially if the prostate was treated.
- Weeks 2 to 4Back to normal activity
Lifting and exercise return gradually after prostate treatment. A brief return of blood is common in this window.
- Weeks 6 to 12Follow-up visit
A flow test and bladder scan check how well you empty. Stone analysis results guide prevention.
- 6 to 12 monthsChecking for new stones
People at higher risk, such as those who use catheters, may have an ultrasound or X-ray to look for new stones.
- Long termKeeping the bladder emptying
If the cause has been fixed, bladder stones usually stay away. If it cannot be fixed, regular checks catch new stones early.
What it feels like
Many people have lived with a stopping stream, pain at the end of urinating or repeated infections for months before the stone is found. Relief after removal is often quick, while the first days with burning and a catheter can be trying.
Before surgery
Embarrassment about urinary symptoms, frustration that it took a while to find the cause, and some relief at finally having an answer.
What helpsAsk your surgeon to explain what caused the stone and how the plan will stop it coming back.
Waking with a catheter
Pressure and a constant urge to urinate even though the bladder is draining, sometimes with sudden cramping spasms.
What helpsTell the nurse about spasms. Medicine and keeping the catheter tube free of kinks help.
The first time you urinate
Burning and urgency, sometimes small clots or gritty bits. Many people notice the stream is already stronger and no longer stops suddenly.
What helpsDrink steadily, sit to urinate if it is easier, and do not push hard.
The first week at home
Tiredness, frequent trips to the bathroom, and pink urine that comes and goes.
What helpsRest, drink well, and keep bowels soft. Short walks help energy.
Afterward
Relief that the pain at the end of urinating is gone, and sometimes worry that the stone will return.
What helpsAsk about your stone analysis and your follow-up plan. Fixing the cause is the best protection.
How well it works
Success means the stone is fully removed, symptoms such as pain and a stopping stream ease, infections stop, and the bladder empties well. Removing all the stone through the urethra succeeds in nearly all people. Whether stones stay away depends mostly on treating the cause.
- Stone-free
The surgeon checks the whole bladder at the end of the operation. Imaging is done later only if needed.
- Better emptying
A flow test and a bladder scan for leftover urine show whether the bladder now empties well.
- Stone analysis
Most bladder stones are uric acid, calcium oxalate or struvite (infection) stones. The type guides prevention.
- Fewer infections
With the stone gone and good emptying, repeated urine infections usually stop.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Pink or red urine for several days, longer if the prostate was treated.
For days to a few weeks.
Cramping while a catheter is in. Medicines help.
Less common
Usually treated with antibiotics. More likely if the urine was infected before surgery.
Swelling or a weak bladder may need a catheter for a few more days.
Common if the cause cannot be fixed, such as in people who need long-term catheters.
Small fragments can be missed and may need another procedure.
Rare
A small tear usually heals with a catheter left in longer. A larger tear may need surgery.
Scar tissue narrowing the urethra weeks to months later, causing a weak stream again.
Infection that spreads to the blood and needs hospital care.
Rare after stone removal alone. Slightly more likely when the prostate is treated.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- You cannot urinate, or your catheter stops draining and your lower belly feels full or painful
- Thick clots or urine like ketchup that does not lighten after drinking more
- Severe pain in your lower belly that your medicines do not control
- Your catheter falls out before the planned removal
- Vomiting that keeps you from holding down fluids or medicines
- Chest pain, shortness of breath, or a swollen, painful leg (call 911 for chest pain or trouble breathing)
Questions to ask your surgeon
- What do you think caused my bladder stone?
- Will you treat my prostate or other cause in the same operation? Which method, and why?
- Will you use a laser or another device to break the stone?
- How large is the stone, and could I need a second procedure or an opening in my belly?
- Will I have a catheter afterward, and for how long?
- Will I go home the same day?
- Could my stone be uric acid, and could it be dissolved with medicine instead?
- Will you send the stone for analysis?
- What can I do to stop new stones from forming?
- How will treating my prostate affect ejaculation and sexual function?
Words you may hear
- Cystolitholapaxy
- Breaking a bladder stone through a scope and washing out the pieces.
- Cystoscope
- A thin telescope passed through the urethra to look inside the bladder.
- Benign prostatic hyperplasia (BPH)
- Non-cancerous enlargement of the prostate, which can block urine flow.
- Post-void residual
- The amount of urine left in the bladder after you urinate, often measured with a quick bladder ultrasound.
- Urinary retention
- Being unable to empty the bladder fully or at all.
- Trabeculation
- Thick, ridged bladder muscle from years of pushing against a blockage.
- Diverticulum
- A pouch that bulges out through the bladder wall and can trap urine and stones.
- Holmium laser
- The laser most often used to break urinary stones.
- Neurogenic bladder
- A bladder that does not work normally because of a nerve or spinal cord problem.
- Uric acid stone
- A stone that forms in acidic urine. It can sometimes be dissolved with medicine.
- Struvite stone
- A stone that forms when certain bacteria infect the urine.
- TURP
- Transurethral resection of the prostate: shaving away the inner prostate through a scope.
- HoLEP
- Holmium laser enucleation of the prostate: removing the inner prostate with a laser through a scope.
Common questions
Why did I get a bladder stone when my kidneys are fine?
Most bladder stones form in the bladder itself because urine is left behind after urinating. An enlarged prostate, a narrowed urethra, nerve problems and long-term catheters are the usual reasons.
Will my prostate be treated too?
Often, if an enlarged prostate is the cause. Treating it in the same operation lowers the chance of new stones. Your surgeon will discuss the options, which include TURP, laser enucleation (HoLEP) and others.
Can the stone dissolve with medicine?
Only uric acid stones, and only sometimes. Potassium citrate makes the urine less acidic and can dissolve them over weeks to months. Most bladder stones need to be removed.
Will it come back?
If the cause is fixed and the bladder empties well, new stones are uncommon. If the cause cannot be fully fixed, as in people who need long-term catheters, stones can return and regular checks are wise.
My stone is very large. Do I need a cut?
Many large stones can still be broken through the urethra, though it takes longer. Very large stones, or a urethra too narrow for the scope, may be removed through a small opening in the lower belly or with open or robotic surgery.
Do bladder stones mean cancer?
No. Bladder stones are not cancer. Your surgeon looks at the whole bladder lining during the procedure, and any area that looks unusual can be biopsied.
Can women get bladder stones?
Yes, though less often. In women they are usually linked to a bladder that does not empty well, a catheter, or stitches or mesh from earlier surgery. The removal is similar.
Sources this page draws on
- European Association of Urology, EAU Guidelines on Urolithiasis (section on bladder stones)
- American Urological Association, Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (BPH): AUA Guideline
- European Association of Urology, EAU Guidelines on Management of Non-neurogenic Male Lower Urinary Tract Symptoms
- MedlinePlus (U.S. National Library of Medicine), Bladder stones
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.