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Cystolitholapaxy

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Definition

Cystolitholapaxy is a procedure to break up bladder stones into smaller pieces and remove them. Bladder stones are minerals that have built up in the bladder. Ultrasonic waves or lasers may be delivered through a tool called a cystoscope to break up the stones.
Bladder Stone
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Reasons for Procedure

This procedure is done to treat bladder stones.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like
  • Urinary tract infection
  • Bladder tear or damage
  • Bleeding
  • Reaction to the anesthesia
  • Infection
  • Damage to internal tissue or structures

What to Expect

Prior to Procedure

Your doctor may do the following:
  • Physical exam and medical history
  • Blood and urine tests
  • Imaging tests
Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure, including:
  • Aspirin or other non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen
  • Blood thinners, such as warfarin
  • Anti-platelets, such as clopidogrel
Other things to remember before the procedure:
  • Arrange for a ride home from the care center.
  • If instructed by your doctor, do not eat or drink for eight hours before the procedure.

Anesthesia

This procedure can be done under local, spinal, or general anesthesia. It will block any pain. Sedation may also be used to ease anxiety.
With local anesthesia, a special jelly or fluid will be inserted into your urethra. This will numb the area. If you are having spinal anesthesia, it will be injected into your spine. General anesthesia will make you stay asleep during the procedure.

Description of Procedure

The doctor will place a tiny flexible probe, called a cystoscope, through your urethra toward the bladder. The probe has a camera for viewing. Imaging guidance, like ultrasound, will help the doctor locate the bladder stones. A saline solution may be flushed through the urinary tract. After a stone is located, the doctor will grab the stone and turn on the device to break it. A special basket or forceps will be used to grab the stone fragments and remove them.
The bladder and surrounding structures will be examined. The doctor may place a stent in your urethra to help protect the lining while the fragments pass or to repair damage.

Immediately After Procedure

Depending on the type of anesthesia used, you may be able to move around after the procedure. You may still have a catheter inside your urethra.

How Long Will It Take?

This is usually done in an outpatient setting. You will not need to stay overnight. The procedure takes 30-60 minutes depending on the size of the stones.

How Much Will It Hurt?

Anesthesia prevents pain during the procedure. Ask your doctor about medication to help with pain after the procedure.

Post-procedure Care

At the Care Center
After the procedure, the care center staff may provide the following care:
  • Monitor you while you recover from the anesthesia and/or sedation
  • Remove any IV needles and the catheter
  • Help you to eat and move around again
  • Give you pain medication
At Home
When you return home, do the following to help ensure a smooth recovery:
  • Take medication as directed to reduce pain and the chance of infection
  • Avoid difficult activity and heavy lifting
  • Drink plenty of fluids
  • Do not drive or have sex until your doctor says it is safe to do so
  • Be sure to follow your doctor’s instructions

Call Your Doctor

Call your doctor if any of the following occurs:
  • Increasing pressure or pain while passing urine
  • Pain in the back or abdomen
  • Not able to urinate
  • Changes in frequency, odor, appearance, or volume of urine
  • Signs of infection, including fever or chills
  • Blood or blood clots in urine after the first few days
  • Painful urination or a burning sensation after the first few days
  • Leaking urine
If you think you have an emergency, call for medical help right away.

RESOURCES

American Urological Association Foundation http://www.urologyhealth.org

National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov

CANADIAN RESOURCES

Canadian Urological Association http://www.cua.org

Kidney Foundation of Canada http://www.kidney.ca

References

Cystoscopy and ureteroscopy. National Kidney and Urologic Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/cystoscopy/. Updated March 28, 2012. Accessed May 22, 2013.

Cystoscopy for women. Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/test%5Fprocedures/gynecology/cystoscopy%5Ffor%5Fwomen%5F92,P07723/. Accessed May 22, 2013.

Marickar YM, Nair N, Varma G, et al. Retrieval methods for urinary stones. Urol Res. 2009;37(6):369-376.

Stoller ML. Chapter 16. Urinary Stone Disease. In: Tanagho EA, McAninch JW, eds. Smith's General Urology. 17th ed. New York: McGraw-Hill; 2008. http://www.accessmedicine.com/content.aspx?aID=3127288. Accessed May 22, 2013.

Urinary calculi. Merck Manual for Healthcare Professionals. Available at: http://www.merckmanuals.com/professional/genitourinary%5Fdisorders/urinary%5Fcalculi/urinary%5Fcalculi.html. Updated November 2012. Accessed May 22, 2013.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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