Name of the Procedure:

Litholapaxy: crushing or fragmentation of calculus (kidney stones) by any means in bladder and removal of fragments; simple or small (less than 2.5 cm).

Summary

Litholapaxy is a medical procedure in which kidney stones located in the bladder are crushed into smaller pieces so they can be washed out of the body. This method is typically used for stones that are simple or small, measuring less than 2.5 cm.

Purpose

Medical Condition Addressed:

• Bladder stones (calculi) ##### Goals/Outcomes:
• To relieve symptoms caused by bladder stones, such as pain, urinary tract infections, and difficulty urinating.
• To remove the stones and restore normal bladder function.

Indications

Symptoms/Conditions:

• Painful urination
• Blood in urine
• Frequent urination
• Difficulty urinating or inability to urinate ##### Patient Criteria:
• Patients with bladder stones that are simple or small (less than 2.5 cm).

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Adjustments to current medications may be necessary.
• Diagnostic tests such as ultrasound or X-rays may be conducted to confirm the size and location of the stones.

Procedure Description

1. The patient is given anesthesia to ensure comfort, which can be local, spinal, or general.
2. A cystoscope (a thin tube with a camera) is inserted through the urethra into the bladder.
3. The stone is located using the camera.
4. Specialized instruments are passed through the cystoscope to crush or fragment the stone.
5. The smaller fragments are then removed from the bladder using suction or forceps.
6. The cystoscope is removed, and the procedure is complete.

Tools and Equipment:

• Cystoscope
• Stone crushing or fragmenting instruments
• Suction devices

Anesthesia:

• Local, spinal, or general anesthesia depending on the patient's condition and preference.

Duration

• Typically takes 30 minutes to an hour.

Setting

• Performed in a hospital or an outpatient surgical center.

Personnel

• Urologist or a specialized surgeon
• Nursing staff
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Infection
• Bleeding
• Injury to the urethra or bladder
• Incomplete removal of stone fragments
• Urinary retention

Benefits

• Relief from symptoms caused by bladder stones.
• Quick recovery time, with most patients experiencing significant improvement shortly after the procedure.

Recovery

• Patients may go home the same day or stay for a short period.
• Mild discomfort or blood in the urine may be experienced for a few days.
• Hydration is essential to help flush out any remaining fragments.
• Follow-up appointments may be necessary to check for the recurrence of stones.

Alternatives

• Medication to dissolve the stones, although this is less effective for larger stones.
• Extracorporeal Shock Wave Lithotripsy (ESWL) to break the stones using sound waves.
• Open surgery or percutaneous nephrolithotomy for larger or more complex stones.

Pros and Cons:

• Litholapaxy is less invasive and has a quicker recovery compared to open surgery.
• ESWL is non-invasive but may not be effective for all stone types.

Patient Experience

• During the procedure, patients will be under anesthesia and should not feel pain.
• Post-procedure discomfort can be managed with pain medications.
• Patients may feel some discomfort during urination for a few days.
• Drinking plenty of fluids will aid recovery and help flush out any remaining stone fragments.