Cystolithotomy Surgery

Cystolithotomy

Cystolithotomy is the removal of bladder stones (vesical calculi) by the surgical route. It is typically advised if the stones are too large to be removed using an endoscope or if the patient is not a candidate for minimally invasive procedures. 

Preoperative Care

• Evaluation by ultrasound, X-ray or CT scan to find and measure the stones.
• Routine blood and urine testing for infection or kidney problems.
• Urinary infection may be treated or prevented by use of antibiotics 

Steps of surgery:

Cystolithotomy may be carried out as an open, laparoscopic or suprapubic depending on the case. The conventional technique is open cystolithotomy:

Open Cystolithotomy

• Anesthesia: The procedure is performed under general or spinal anaesthesia. 
• Incision: It is a tiny cut in the lower abdomen (suprapubic). 
• Identification of the Bladder: Bladder is recognized and opened. 
• Stone Removal: Stone removal is done manually.
• Bladder closure: The bladder is closed in layers to make the bladder watery tight.
• Insertion of the Catheter: For urine drainage while healing, a Foley catheter is necessary.
• Closure: Following the procedure, the abdominal wound is closed. 

Laparoscopic Procedure

• Makes small incisions by the keyhole and laparoscope.
• The removal of stones is done using special instruments.
• Fewer postoperative pains and faster healing

Cystolithotomy surgery

Cystolithotomy is an operation for the removal of vesical calculi, where they are too large and hard to extract with endoscopy. This could be done through an open or laparoscopic procedure, the open suprapubic cystolithotomy being the standard and most widely taught procedure.

Preparation before Surgery

• Clinical examination and investigations 
• Urine test for infection
• Evacuating the bladder before anaesthesia. 
• Informed consent on risks and benefits.

Anaesthesia

• Typically done under general anaesthesia.
• In some patients, spinal anaesthesia can be applied as well.

Patient Positioning

• Patient is in the prone position.
• Perineal and abdominal region are sterile cleansed and covered.

Incision

• A Pfannenstiel (transverse suprapubic) or lower midline incision is then made, which is usually 4-8cm above the pubic bone.
• This opens up the subcutaneous tissues and rectus sheath to access the bladder.

Exposing the Bladder

• The dome of the bladder is recognized.
• Stay sutures are sewn on the bladder wall so as to aid in raising and stabilizing the bladder wall.

Bladder (Cystotomy) Opening

• The bladder is cut either vertically or transversely.
• Urine has to be suctioned to visualize better.

Stone Removal

• Stones are either found using their eyes or fingers.
• The stones, big and small, are all caught by using forceps.
• Saline is used to irrigate the bladder in order to remove the remaining debris.

Inspection of the Bladder

• Diverticula, bladder mucosa and bladder neck are examined.
• Any related pathology (such as foreign body or obstructive lesion) is reported.

Bladder Closure

A two-layered bladder closure with most often absorbent suture is done:

• Inner mucosal layer
• Outer muscular layer
• Guarantees a tight and sound closure.

Catheter Placement

• Foley catheter is inserted via urethra to ensure that the bladder remains drained.
• A suprapubic catheter can also be placed some times.

Abdominal Closure

• There is a closed rectus sheath, subcutaneous tissue and skin.
• Sterile dressing is applied.

Emergency Postoperative Services

• Urine output, bleeding and infection monitoring.
• Antibiotics and pain management.
• Foley catheter typical retention of 5-10 days.

Cystolithotomy recovery

Recovery following cystolithotomy (removal of bladder stones through an open wound) is normally painless. There is healing of the bladder, healing of incisions, healing of catheters, and prevention of recurrent stones.

Hospital Stay

• Average length of stay is 2- 4 days.
• Observations entail the urine output, wound on the abdomen, and infection indicators.

Catheter Care

• A Foley catheter is retained in the bladder over a period of 5-10 days so that the incision in the bladder can heal.
• The catheter empties the bladder at all times so as to avoid stress on the sutures of the bladder.

Important points:

• Maintain the catheter tube as clear and clean.
• Do not pull or tug on it.
• Make sure that the urine bag does not exceed bladder level.

Pain and Discomfort

• The pain in the lower abdomen is mild to moderate. 
• Symptoms of pain are normally managed by prescription painkillers.
• A certain burning or higher frequency that may arise after catheter removal may take 1-3 days.

Diet

• On the first day, begin with light meals.
• Adequate hydration (2- 3 litres/day, except limited intake).
• They should be avoided in case they are irritating: carbonated and caffeinated drinks. 

Activity Restrictions

• Limit lifting, bending, and straining for 4 to 6 weeks.
• Walking is recommended post-surgery to prevent clots and promote healing. 
• Sex should be avoided 2-3 weeks or till the catheter is taken away and healed.

Wound Care

• Maintain a clean dry abdominal incision.
• Sutures or staples (if used) are removed 7-10 days after surgery. 

Follow-Up

• The follow up is usually 1-2 weeks post discharge. 
• To be sure to get rid of all the stones, imaging can be done. 
• Uroflow or additional investigation whether it was obstruction as the cause.

Cystolithotomy complications

Cystolithotomy is not very dangerous, although, like all surgical operations, some complications may arise. They can be treated easily and within a short period.

• Urinary Tract Infection
• Hematuria
• Bladder Leakage
• Wound Infection
• Catheter-Related Problems
• Injury to Adjacent Structures
• Bladder Stones Recurrence
• Prolonged Urinary Symptoms
• Anastomotic Breakdown

Best hospital for cystolithotomy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Cystolithotomy is a strong and successful surgical intervention to erase gigantic or complicated bladder stones that cannot otherwise be removed using endoscopic or minimally invasive technologies. The operation gives full clearance of the stones, alleviates urinary symptoms and avoids complications including infection, obstruction and bladder injury. Most patients make an easy recovery after a few weeks with available aftercare measures such as managing catheters, wound care and hydration. To ensure a reduction of the occurrence, it is important to correct the underlying causes of stone formation, including prostate enlargement, strictures, or chronic infections. All in all, cystolithotomy continues to be a safe and useful modality of dealing with problematic bladder stones.

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FAQ

1. Is the surgery painful?

• The discomfort is mild to moderate and can be controlled with medication. Most of the pain will go away in a few days. 

2. Will I have catheter after the surgery?

• Yes. In order to let the bladder heal without exerting pressure on the sutures, a Foley catheter is kept in place for 5 to10 days. 

3. Will the stones come back?

• Recurrence can occur unless the underlying cause, which could be enlargement of the prostate glands, stricture, inefficient emptying of the bladder, or frequent infections is mitigated. The prevention such as hydration and frequent follow up can lessen recurrence.

4. Is cystolithotomy safe for children?

• Yes. It is usually done in children who are having large bladder stones or in cases when least invasive interventions cannot be used. The recovery normally proceeds without complications.