Cystolithotomy

Cystolithotomy is a urologic procedure to remove one or more bladder stones.

It is typically performed for a patient with large or numerous bladder stones or if an endoscopic approach has not been successful. 

The traditional approach described below is an open cystolithotomy. Other approaches potentially available

  • percutaneous endoscopic cystolithotomy
  • transurethral endoscopic cystolithotomy
  • extracorporeal shockwave lithotripsy
  • chemodissolution

Each procedures has benefits and disadvantages, and the indications for each have not yet been generally agreed upon. The open procedure is the most effective, but carries a significant morbidity. The transurethral approach is most commonly used, but may be ineffective for larger stones. Percutaneous cystolithotomy has shown some promising results on treating calculi in a reconstructed or augmented bladder 2,3.

Chemodissolution (e.g. urease inhibitors for struvite stones) are not commonly used since they require a great deal of time and may not be effective.

Procedure

The open procedure involves incising the bladder and removing the bladder stones. It can either be performed as a single procedure or as part of another urologic procedure (e.g. prostatectomy).

Technique
  • a Foley catheter is introduced into the bladder and sterile water is introducted into the bladder
  • skin is incised over the ventral midline pelvis, between the rectus muscles
  • dissection down to the anterior bladder wall; the approach is kept extraperitoneal
  • the destrusor muscle is incised vertically
    • the bladder is only opened large enough to remove the stone
  • if the stone is large and the incision is wide, a suprapubic catheter is left in place
  • bladder is sutured closed and an extraperitoneal drain is left near the bladder closure
  • after 7-10 days a cystogram can assess to see if there is any leakage

Complications

  • postoperative bladder leak
  • infection
Urologic procedures
Share article

Article Information

rID: 40212
System: Urogenital
Synonyms or Alternate Spellings:

Support Radiopaedia and see fewer ads

Cases and Figures

  • Drag
    Case 1: removed by open cystolithotomy
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.