Cystolitholapaxy is a surgical procedure to break down stones in the bladder. Bladder stones occur due to the accumulation of minerals either in the bladder or the kidney, causing pain as they grow in size. If originated in the kidney, they may move to the bladder through the ureter and eventually cause difficulty and pain while urinating.
With the help of an instrument known as a cystoscope, lasers or ultrasonic waves fragment bladder stones and ensure the removal of any pending pieces. This operation is safe and minimally invasive.
The scientific name is cystolitholapaxy.
The urinary bladder.
How is it Performed
The cystoscope is introduced into the urinary bladder through two approaches. Based on these methods, cystolitholapaxy can be classified into:
In both methods, once the procedure is complete, the cystoscope is removed and the incisions are closed. A Foley catheter is placed in the urethra and attached to a urinary bag to frequently drain urine from the body.
In this method, the cystoscope is introduced through the urethra, into the urinary bladder. An instrument that emits laser or ultrasound waves is inserted through the cystoscope and breaks down the stones. Any remaining fragments can be removed through suction and irrigation.
This method is least invasive and is often preferred, as it is performed under spinal anesthesia and does not require surgical incisions. Post-operative pain is lesser, thus making recovery faster.
The cystoscope is introduced into the bladder through small incisions made in the urinary bladder and abdomen. Similar to the transurethral procedure, the stones are then broken down and removed.
Due to narrow urethras in young children, the cystoscope cannot pass through. In adults with large bladder stones, where the transurethral procedure may be difficult, this procedure works well. However, the recovery time is longer due to greater postoperative pain.
A series of tests are conducted before the surgery, including:
To check the electrical activity of the heart before surgery.
To ensure that the patient is completely fit for surgery.
To detect high levels of specific substances, and to check hemoglobin levels, blood group, as well as liver and kidney function.
- To detect high levels of minerals and crystals, which cause stone formation. They also test the presence of blood in the urine. Before any procedure, a urine infection must be ruled out.
CT scans and ultrasounds
To accurately test for the presence of bladder stones. However, ultrasounds cannot detect all types of stones.
This is the procedure of tests to be conducted before the surgery:
- A few days before the surgery, the doctor will require some routine tests.
- One week before the surgery, doctors advise against taking medication like aspirin.
- Hospital check in will be one day before surgery.
- Overnight fasting is a prerequisite.
- Informed consent is required.
Anesthesia will be administered before surgery
- General or spinal anesthesia during transurethral cystolitholapaxy
- General anesthesia during percutaneous cystolitholapaxy
- Transurethral Cystolitholapaxy Minimally invasive surgery
- Percutaneous Cystolitholapaxy Percutaneous surgery
Once the procedure has been completed and the anesthesia wears off, the patient is then shifted to the recovery room. Thereafter, the patient is encouraged to drink lots of fluids.
Antibiotics are prescribed to prevent infections, along with pain relievers in case any postoperative discomfort persists.
If the patient notices blood in their urine post-surgery, it is not a cause for worry. The urine soon becomes clear.
Post-surgery, the patient needs to move around as much as they can. If the patient is doing well, the doctor may permit the patient to be discharged from the hospital on the same day.
Looking after the urine bag and emptying it are some postoperative instructions that will be provided by the doctor.
There are a few risks associated with cystolitholapaxy, including:
- Burning sensation while urinating
- Urinary tract infection (antibiotics are prescribed to prevent infections)
- Urinary bladder perforation
- Difficulty in passing urine, or frequent urination
- Tissue damage, which can lead to the narrowing of the urethra and consequent scar tissue formation
- The recurrence of stones or an unsuccessful procedure might require open surgery in the future
- General complications from the surgery or anesthesia such as deep vein thrombosis
- Daily activities Regular walks prevent blood clots from forming in the leg post-surgery. 2-5 days after the surgery, the patient can resume all kinds of sports and vigorous activities. Showers can also be resumed once the catheter is removed.
- Diet Once at home, no special diet is required post-surgery.
- Work Within 2-3 days, the patient can return to their work, but heavy lifting or strenuous activities should be avoided for 1-2 weeks after surgery.
- Antibiotics These are as prescribed by the doctor.
- Catheter The catheter attached to the urine bag is removed 24-48 hours after the surgery.
- Re-examination 4-6 weeks post-surgery, a follow-up appointment is to be scheduled with the doctor.
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