Cystolitholapaxy Overview

This 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 © 2009 Nucleus Medical Media, Inc.

Prior to Procedure

Your doctor may do the following:

• Physical exam, blood and urine tests, and imaging tests

• Discuss with you the type of anesthesia that will be used and the potential risks

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

• Aspirin or other anti-inflammatory drugs

• Blood thinners, like warfarin (Coumadin)

• Clopidogrel (Plavix)

Other things to keep in mind before the procedure:

• Arrange for a ride home from the hospital.

• 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 (the tube that carries urine out of the body). This will numb the area. If you are having spinal anesthesia, it will be injected into your spine. General anesthesia will be given through an IV (needle in your arm).

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. Once a stone is located, the doctor will grab the stone and turn on the device to break it. To do this, different types of technology (eg, ultrasonic waves, lasers, or a mechanical device) can be used. 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 (or longer) depending on the size of the stones.

How Much Will It Hurt?

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

Post-procedure Care

At the Care Center

After the procedure, the hospital 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 medicine

At Home

When you return home, do the following to help ensure a smooth recovery:

• Take medicines as directed to reduce pain and the chance of infection.

• Avoid hard activity and heavy lifting.

• Drink plenty of fluids (eg, 8-10 glasses per day).

• Do not drive or have sex until your doctor says it is safe to do so.

• Be sure to follow your doctor’s instructions.

RESOURCES:

American Urological Association
http://www.auanet.org/

National Institute of Diabetes and Digestive and Kidney Diseases
http://www2.niddk.nih.gov/

CANADIAN RESOURCES:

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

Health Canada
http://www.hc-sc.gc.ca/index-eng.php

References:

Ho KL, Segura J. Lower Urinary Tract Calculi: Cystolitholapaxy. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders Elsevier; 2007:chap 84.

Mayo Clinic. Bladder stones: treatment and drugs. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/bladder-stones/DS00904/DSECTION=treatments-and-drugs . Updated January 16, 2010. Accessed August 12, 2010.

Neff D. Electrohydraulic lithotripsy. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated August 12, 2010. Accessed August 12, 2010.

University of Wisconsin Health. Cystoscopy with bladder biopsy, cystolitholapaxy. University of Wisconsin Health website. Available at: http://www.uwhealth.org/healthfacts/BEXTRANETHEALTHINFORMATION-FlexMember-ShowPublicHFFY1104449356655.html. Updated July 3 , 2009. Accessed August 12, 2010.