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
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.
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).
- 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 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
- postoperative bladder leak
- 1. Jr JAS, Howards SS, Preminger GM. Hinman's Atlas of Urologic Surgery. Saunders. ISBN:1416042105. Read it at Google Books - Find it at Amazon
- 2. Breda A, Mossanen M, Leppert J et-al. Percutaneous cystolithotomy for calculi in reconstructed bladders: initial UCLA experience. J. Urol. 2010;183 (5): 1989-93. doi:10.1016/j.juro.2010.01.033 - Pubmed citation
- 3. Docimo SG, Orth CR, Schulam PG. Percutaneous cystolithotomy after augmentation cystoplasty: comparison with open procedures. Tech Urol. 1998;4 (1): 43-5. Pubmed citation
- 4. Philippou P, Moraitis K, Masood J et-al. The management of bladder lithiasis in the modern era of endourology. Urology. 2012;79 (5): 980-6. doi:10.1016/j.urology.2011.09.014 - Pubmed citation
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spinal interventional procedures (general)
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- sacroiliac joint injection
- spinal epidural injection
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