Name of the Procedure:

Cystolithotomy (Cystotomy with Removal of Calculus, Without Vesical Neck Resection)

Summary

Cystolithotomy is a surgical procedure to remove stones (calculi) from the bladder. The stones are removed through an incision made in the bladder without resecting (cutting out) the neck of the bladder.

Purpose

Cystolithotomy is performed to address bladder stones, which can cause pain, infection, urinary obstruction, and other urinary tract issues. The goal is to relieve symptoms and prevent recurrence of stones or further complications.

Indications

• Persistent or recurrent bladder stones
• Symptoms such as severe pain, blood in the urine (hematuria), urinary tract infections
• Blockage or obstruction caused by bladder stones
• Failure of less invasive treatments to remove bladder stones

Preparation

• Patients may be instructed to fast for 6-8 hours before the procedure.
• Adjustments to medications, especially blood thinners, may be necessary.
• Preoperative tests can include blood work, urine analysis, and imaging studies like ultrasound or CT scan to determine the size and location of the stones.

Procedure Description

1. The patient is positioned appropriately for access to the bladder.
2. General or regional anesthesia is administered.
3. An incision is made in the lower abdomen to access the bladder.
4. The bladder is opened (cystotomy) to expose the stones.
5. Stones are removed using surgical instruments.
6. The bladder is closed with sutures.
7. The abdominal incision is closed.
8. A catheter may be placed to drain urine while the bladder heals.

Duration

The procedure typically takes around 1 to 2 hours, depending on the number and size of stones.

Setting

Cystolithotomy is usually performed in a hospital or a specialized surgical center.

Personnel

• Urologist or general surgeon
• Anesthesiologist
• Operating room nurses and surgical technologists

Risks and Complications

• Common risks: infection, bleeding, pain at the incision site
• Rare risks: injury to the bladder or surrounding organs, formation of a fistula (abnormal connection), deep vein thrombosis, or anesthesia-related complications
• Possible complications: recurrent stones, urinary incontinence, or prolonged recovery time

Benefits

• Relief from symptoms caused by bladder stones
• Decreased risk of urinary tract infections and obstruction
• Improved urinary function and comfort
• Benefits are usually realized shortly after recovery from surgery

Recovery

• Hospital stay of 1-2 days may be required.
• Patients should follow specific post-operative instructions, including pain management and activity restrictions.
• Catheter care instructions if one is placed.
• Follow-up appointments to monitor healing and prevent recurrence.
• Most patients can return to normal activities within 2-4 weeks, avoiding heavy lifting and strenuous activity during this period.

Alternatives

• Extracorporeal shock wave lithotripsy (ESWL): Non-invasive, uses sound waves to break up stones
• Cystoscopic stone removal: Minimally invasive, uses a scope to break and remove stones
• Medication and dietary changes: To prevent stone formation but may not be effective for existing stones
• Pros and cons vary based on the size and number of stones, patient's health, and risk for complications.

Patient Experience

• During the procedure: Under anesthesia, so no pain is felt.
• After the procedure: Pain and discomfort at the incision site, managed with medications.
• Some bladder discomfort and potential blood in the urine initially.
• Gradual improvement in symptoms as recovery progresses.
• Follow all post-operative care instructions for best outcomes and quicker recovery.