Dr. med. Dirk Manski



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Cystolitholapaxy: Transurethral or Percutaneous Procedure

Indications for Cystolitholapaxy

Bladder stones are treated surgically by endoscopic cystolitholapaxy or open surgery. The decision between endoscopic or open surgery depends on the size of the stones, number of stones and size of the prostate, if simultaneous treatment of benign prostatic hyperplasia is sought.

Contraindications for Cystolitholapaxy

Surgical Technique of Cystolitholapaxy

Patient preparation, anesthesia and perioperative antibiotic prophylaxis see section Transurethral Resection of the Prostate.

Mechanical lithotripsy with a Stone Punch:

A stone punch is introduced through the resectoscope with a 5-degree optic. The stone is desintegrated (like with a nutcracker) into large fragments, which can be retrieved via the resectoscope [fig. cystolitholapaxy with a stone punsh].



Cystolitholapaxy with a stone punch: bladder stones (left). Grasping the bladder stone with the stone punch (middle). Fragmented bladder stones (right).
fig. Cystolitholapaxy with a stone punch

Electrohydraulic Lithotripsy (EHL):

The electric discharge triggered by a probe results in a pressure wave in the vicinity of the bladder stone, which leads to desintegration [fig. electrohydraulic lithotripsy].


Electrohydraulic lithotripsy: positioning the probe in vicinity of a bladder stone (left). Result after several shock waves (right).
fig. Electrohydraulic lithotripsy of bladder stones

Pneumatic Lithotripsy:

Pneumatic lithotripsy will transmit mechanical energy via a rigid probe on the stone. For bladder stones, 8 CH-probes are available.

Removal of Fragmented Stones:

Fragmented stones can be removed directly with the stone punch. In cases with a large stone burden, the stone fragments are removed with the bladder syringe or with the Ellik bladder evacuator.

Percutaneous Cystolithotomy

Percutaneous Cystolithotomy is indicated in children or patients with large stone burden. After percutaneous puncture of the bladder and insertion of a guide wire, an access tract with 24–36 CH is established. Stone fragmentation and removal is similar to percutaneous nephrolithotomy.

Complications of Cystolitholapaxy

Perforation of the bladder is a typical complication. Beware of using the electrohydraulic lithotripsy near the bladder wall. Caution in grasping the bladder wall with the stone punch.

Further complications are bleeding, infection, urethral injury. Conversion to open surgery is necessary, if the stone burden was underestimated.







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References



  Deutsche Version: Harnblasensteinlithotripsie