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Cystolithotomy: Technique and Complications of Sectio Alta

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 cystolithotomy, since in former times, perineal surgery was more 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 infections, and 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, and control bleeding.
• If necessary, perform a 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

General measures:

Early mobilization, analgesics, thrombosis prophylaxis, laboratory tests (hemoglobin, creatinine), regular physical examination of the abdomen and incision wound.

Drains and Catheters:

• The pelvic drain is removed if the daily drainage volume is well below 50 ml.
• Bladder catheter for five days, consider cystography for complicated cases.

Complications of Cystolithotomy

Urinary tract infection, bleeding requiring intervention or transfusion, wound infection, urinoma, thrombosis, pulmonary embolism.

References

  Deutsche Version: Sectio alta