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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
- 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
Care after Cystolithotomy
Early mobilization. Thrombosis prophylaxis. Analgesia with e.g. metamizol and tramadol. Laboratory controls (Hb). Wound inspections.
Drains and Catheters:
- Wound drainage 1–2 days
- Foley catheter for 5 days, do cystography before catheter removal
Complications of Cystolithotomy
Urinary tract infection, bleeding, wound infection, urinoma, thrombosis, pulmonary embolism.
Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Deutsche Version: Sectio alta