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 (ESWL)
- 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 introduced 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 detrusor 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