Cystolithotomy: Surgery for Bladder Stones

Cystolithotomy (sectio alta) is the surgical removal of bladder stones via a lower abdominal incision. The term sectio alta refers to the historical techniques of bladder stone surgery, since in former times perineal surgery was common (sectio lateralis and sectio mediana).

Indications for Sectio Alta

Bladder stones (Cystolithotomy), see also transurethral cystolitholapaxy
Removal of foreign bodies in the urinary bladder
Treatment of bladder tamponade and severe bladder bleeding, which cannot be managed via transurethral surgery

Contraindications for Cystolithotomy

Contraindications for planned surgery are: coagulation disorders, untreated urinary tract infection, bladder cancer.

Surgical Technique of Cystolithotomy

Preoperative Patient Preparation

Exclusion or treatment of a urinary tract infection
Perioperative antibiotic prophylaxis
Supine position with slight hyperextension of the lumbar spine
Disinfection and draping
Insert a transurethral catheter and fill the bladder with 200–300 ml

Surgical Technique

Lower midline incision or Pfannenstiel incision
Cut the linea alba
After blunt dissection of the retropubic space (cavum retzii), insert a wound retractor
Vertical cystostomy, which is secured with sutures to prevent further tearing
Remove bladder stones, foreign bodies or bladder tamponade, controll bleeding.
If necessary, perform simple prostatectomy
If needed, insert a suprapubic catheter
Close the bladder in two layers (mucosa – muscularis)
Drainage of retropubic space
Closure of the linea alba, skin closure