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)
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 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
- 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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