Cystolithotomy

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 .

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