Scientific Editor: Editorial Board ISUD website

When is Cystolithotripsy performed?

Cystolithotripsy aims at treating urinary bladder stones. It is a therapeutic option indicated for almost all bladder stones, with the exception of the very large ones. 

What sort of preparation is required?

Upon hospital admission, preoperative preparation includes blood tests, chest X-ray and ECG (electrocardiogram). In case you are on anticoagulant therapy, it may be required to interrupt your anticoagulant therapy a few days before the operation. You should always consult your Cardiologist, for there may be need to replace anticoagulants with injections in the abdominal region. 

How is Cystolithotripsy performed?

Cystolithotripsy is performed under general or spinal anesthesia. Initially, the patient is placed in the gynaecological examination position, the genital region gets cleansed and the urethra lubricated. A camera is inserted through the urethra to localize the stones. An instrument attached to the camera, the lithotripter, is used to crush stones into small pieces and remove them. At the end of the procedure, a catheter is placed. In case of hematuria (blood in the urine), there is need for continuous bladder irrigation.

Average length of hospital stay is about 2 days.

The catheter is removed as soon as urine clears up from blood. On average, this happens on the first postoperative day.

The most commonly used lithotripters are:

a) ballistic lithotripters (with a mechanism similar to a biologic ‘pneumatic hammer’) 

b) electrohydraulic lithotripters (with the technology of electrical underwater spark-gap discharge) 

c) various types of LASER lithotripters. 

In most cases, bladder stones are formed because of stagnant urine that remains in the bladder due to some obstruction. Among the most common causes of obstruction are benign prostate hyperplasia (enlargement of the prostate gland) or urethral stricture.  That is why Cystolithotripsy usually goes together with obstruction treatment (see TUR-P, Optical Urethrotomy etc)

What about after Cystolithotripsy?

During the first postoperative days, you may have a feeling of burning in the urethra and observe blood in the urine. Also, the catheter may cause bladder spasm and strong pain that lasts a few seconds and reccurs at regular time intervals. These symptoms can improve with proper pharmacotherapy. The presence of blood in urine may prolong the use of catheter or application of continuous bladder irrigation.

Once the catheter is removed, the urination mechanism has to be monitored with ultrasound in order to identify whether there is residual urine remaining in the bladder after voiding.

Upon discharge from hospital, you will given specific written instructions about:

  • what antibiotic regimen you will have to take
  • how long you should abstain from any physical activity
  • how necessary it is to drink plenty of fluids

You should consult your physician about when to restart your anticoagulant treatment. 

What is the effect of Cystolithotripsy on patient’s quality of life?

Most patients have absolutely no problem after the intervention. In some cases, stones may recur when the actual aetiological cause has not been eliminated. That is why you should consult a Specialist Urologist to investigate the cause and treat it.

With regard to your nutrition after Cystolithotripsy, you should be receiving 1500ml of fluids/ day and avoid smoking, drinking coffee and alcohol, as these may induce irritative symptoms.