Name of the Procedure:

Litholapaxy: Crushing or fragmentation of bladder calculus (stones) by any means and removal of fragments; complicated or large (over 2.5 cm).

Summary

Litholapaxy is a medical procedure where bladder stones larger than 2.5 cm are broken down or fragmented into smaller pieces using various techniques, and the fragments are then removed from the bladder.

Purpose

The purpose of litholapaxy is to treat bladder stones that are too large to pass naturally. The goal is to alleviate symptoms, prevent urinary tract infections, and avoid potential damage to the bladder and kidneys.

Indications

• Presence of bladder stones larger than 2.5 cm.
• Symptoms such as severe pain, frequent urination, blood in urine, or inability to urinate.
• Recurrent urinary tract infections caused by the stones.
• Bladder stones causing obstruction or other complications.

Preparation

• Patients may be required to fast for a few hours before the procedure.
• Stopping certain medications like blood thinners may be necessary.
• Pre-procedure diagnostic tests such as ultrasound or CT scans to assess the size and position of the stones.

Procedure Description

1. Sedation/Anesthesia: The procedure is typically done under general or spinal anesthesia.
2. Inserting a Scope: A cystoscope (a thin, tube-like instrument with a camera) is inserted through the urethra into the bladder.
3. Stone Fragmentation: Various methods like laser lithotripsy, ultrasound, or mechanical devices are used to break the stone into smaller pieces.
4. Removal of Fragments: The broken pieces of the stone are flushed out or removed using special tools.

Duration

The procedure usually takes between 30 minutes to 2 hours, depending on the complexity and size of the stones.

Setting

Litholapaxy is generally performed in a hospital or an outpatient surgical center.

Personnel

• Urologist (surgeon specializing in the urinary tract)
• Anesthesiologist or nurse anesthetist
• Nursing staff and surgical assistants

Risks and Complications

• Infection
• Bleeding
• Injury to the bladder or urethra
• Recurrence of stones
• Anesthesia-related complications

Benefits

• Relief from pain and urinary symptoms.
• Prevention of recurrent urinary tract infections.
• Preservation of bladder and kidney function.

Recovery

• Patients may experience some discomfort and burning sensation during urination for a few days.
• Drink plenty of fluids to help flush out any remaining fragments.
• Follow-up appointments to monitor recovery and ensure no fragments remain.
• Avoid strenuous activities for a short period as advised by the doctor.

Alternatives

• Extracorporeal shock wave lithotripsy (ESWL): Non-invasive but limited to smaller stones.
• Percutaneous nephrolithotomy (PCNL): A more invasive procedure used for very large stones or stones in the kidney rather than the bladder.
• Medication to dissolve certain types of bladder stones, though this is often less effective for large stones.

Patient Experience

• During the procedure: Patients will be under anesthesia and should not feel pain.
• After the procedure: Some discomfort or burning during urination, managed with pain relievers. Hydration is encouraged to assist in passing any remaining fragments.
• Follow-up: Regular check-ups to ensure complete removal of stones. Possible dietary and lifestyle modifications to prevent recurrence.