Cystoscopic Fragmentation of Bladder Stone

Cystoscopic fragmentation bladder stone

Cystoscopic fragmentation is a non-invasive surgery that involves the dissection and removal of bladder stones with an endoscope via the urethra. It does not involve open surgery and is associated with fast recovery.

Preparation

• General blood and urine screening.
• Other: Ultrasound or CT scan.
• Fasting for 6–8 hours
• Spinal or general anaesthesia is used.

How To Do It

• A cystoscope — either flexible or rigid — is inserted through the urethra and into the bladder.
• Saline is introduced into the bladder for better visualization. The camera is used to locate the stone.

Breaking the stone: energy source is used:

• Holmium:YAG laser
• Pneumatic lithotripter
• Ultrasonic lithotripter

The broken fragments are eliminated with:

• Stone graspers
• Suction
• Ellick evacuator
• Final inspection is made so that there is nothing left as fragments.
• Temporary placement of a Foley catheter can be done in case of necessity.

Cystolithotripsy procedure

Cystolithotripsy is the procedure performed through the urethra to the bladder in order to break the stones into tiny fragments and remove them using minimal invasiveness.

They are usually done with the help of a cystoscope and powered by laser, pneumatic or ultrasonic devices.

Types of Cystolithotripsy

Transurethral Cystolithotripsy

• Most common
• Cystoscopy by inserting cystoscope via urethra.
• Stone carvings of small and medium scale.

Percutaneous Cystolithotripsy

• Applied to children or to provide access to urethra in cases of difficulty.
• A tiny hole is formed above the pubic bone into the bladder.

Video Cystolithotripsy Procedure

• Pre-Procedure Preparation
• Blood analysis, urine analysis, radiography (USG/CT)
• Fasting for 6–8 hours
• Spinal or general anaesthesia
• Prophylaxis antibiotics can be administered.

Procedure Steps

Insertion of Cystoscope

• With a rigid or flexible cystoscope, a rigid scope is inserted through the urethra to the bladder.
• Saline is used in bladder to be able to see clearly.

Stone Identification

• Camera locates the stone(s).
• Measurements of size, number, and composition were visually measured.

Stone (Lithotripsy) Fragmentation

Using one of the following:

• Laser (Holmium:YAG) - most useful, specific.
• Pneumatic lithotripter -Vibration to split stones.
• Ultrasonic lithotripter- emulsifies and aspirates a fragment of stone.
• Electrohydraulic lithotripter (EHL) - obsolete technique. 

The removal of Stone Fragments

• Suction devices
• Ellik evacuator
• Graspers or basket retrieval.

Bladder Inspection

• Check for remaining pieces
• Check bladder wall(s) of injury or inflammation.

Catheter (when necessary) insertion

• Foley catheter can last 12- 48 hours.
• E.g., in case of bladder irritation or bleeding.

Cystoscopic fragmentation recovery

The following is an easy to understand patient-centered structured summary of Cystoscopic Fragmentation (Cystolitholapaxy) Recovery.

Immediate Post-Procedure

• Majority of patients discharge on the same day or sometimes an overnight.
• In case of swelling or bleeding, a Foley catheter can be retained 12-48 hours.

You may notice:

• Painful urination, mild in nature.
• 24-48 hours of pink or slightly bloody urine.
• More frequent and urgent 1-3 days.
• They are natural and normally resolve themselves.

First 48 Hours

Expected:

• Mild discomfort
• Small stones in urine periodically.
• Slight bladder spasms

Instructions to Care:

• Drink 2.5-3L water every day. 

Avoid:

• Exclusive physical exercise.
• Long travel
• Heavy lifting

1 Week After Surgery

• The vast majority of the patients recover completely in 3-7 days.

You can expect:

• Pain slowly fading away.
• Urine normal colour recovering.
• Reduced urinary urgency
• Comfort in daily activities

Avoid for 1 week:

• Gym, sports
• Sexual Activity
• Alcohol, caffeine (can cause bladder irritation), 

Preventive Strategies for Long-Term Avoidance of Relapse 

• Consume water on a regular basis.

Treat underlying causes:

• Prostate enlargement
• Chronic infections
• Bladder emptying problems
• Take stone type dietary advice.
• Frequent follow up by ultrasound in case of recurring stones.

Bladder stone fragmentation complications

Though, this method of bladder stone fragmentation is considered to be safe and with minimum invasiveness, certain complication may arise. Most are mild and temporary.

Common & Mild Complications

• Burning Sensation During Urination
• Blood in Urine
• Urinary Frequency & Urgency
• Bladder Spasms

Infection-Related Complications

• Urinary Tract Infection
• Sepsis

Complications of Injuries

• Trauma to the Urethra or Urethritis 
• Urethral Stricture
• Bladder Wall Injury

Stone-Related Complications

• Residual Stone Fragments
• Recurrent Bladder Stones

Complications of Catheters

• Discomfort
• Blood clots blocking the catheter
• Irritation and bladder muscle spasms
• Typically clear up after catheter removal.

Anaesthesia-Related Complications

• Nausea and vomiting
• Allergic reaction 
• Hypotension
• Headache 

Best hospital for cystoscopic bladder stone fragmentation India

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

Conclusion

Cystoscopic fragmentation of bladder stones (cystolithotripsy or cystolitholapaxy) is a safe, effective, and minimally invasive therapy of bladder stones. It allows:

• Accurate stone fracturing with laser, pneumatic or ultrasonic fracture tools.
• Removal by way of the urethra with minimum surgery being open.
• Quick healing and brief hospitalization.
• Fewer complications as compared to open surgery.

Proper pre-operation examination, exquisite operation and post-operation care are essential to reduce risk. To ensure recurrence is prevented, long-term success is gained through treating underlying causes. Proper follow-up would help the patients to have a rapid recovery and see the long term normalization of bladder health.

Cystoscopic bladder stone fragmentation India GetWellGo

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FAQ

1. Is the procedure painful?

• The operation will be performed in either spinal or general anaesthesia and therefore you will not experience pain throughout the operation.
• Slight urinary bleeding and mild burning of the urine can take place after 12 hours to 2 days later.

2. What is the duration of the process?

• Usually, 20-60 minutes, depending on the size and quantity of stones

3. Can stones come back?

• Yes, if the cause of the obstruction (prostate enlargement, infections, neurogenic bladder) is addressed. 
• Preventions that you can take are hydration, infection treatment, and follow-ups. 

4. Can all the bladder stones be removed this way? 

• A majority of stones are cystoscopically treatable.
• Large or complicated rocks might demand open surgery or the staged operation.

5. Am I supposed to have a catheter following the operation?

Not always.

• The Foley catheter can only be inserted temporarily in case of bladder irritation, bleeding, and inability to empty the bladder.

6. Is fragmentation during cystoscopy safe?

• Yes, it is safe and effective with low risks as compared to open bladder stone operant procedure.