Introduction
Transurethral cystolitholapaxy is a surgical treatment performed to treat bladder stones in adults. Small stones may flush out by drinking a lot of water, but they may not occur if complete emptying of urine from the bladder is not happening. Transurethral cystolitholapaxy is a safe and efficient technique to manage bladder stones in which the bladder stones are broken into small pieces and removed.
What Is Transurethral Cystolitholapaxy?
Transurethral cystolitholapaxy is a surgical technique that treats bladder stones. Transurethral cystolitholapaxy consists of an endoscope, a continuous-flow component, a jaw for handling and removing the stones, a lithotripsy tube, a handle, an inner sheath, and an outer sheath for performing the procedure. A small, rigid tube called a cystoscope is inserted into the urethra to reach the bladder. The cystoscope consists of lenses like a tiny telescope or microscope. This helps in locating bladder stones. Some cystoscopes have optical fibers that pick up an image from the instrument's tip.
After inserting the cystoscope, lasers or ultrasound waves are used to transmit pulses of energy through the cystoscope. This breaks the stones into fragments, and these particles are removed through the cystoscope. A crushing device is used for crushing large stones. This crushes and breaks the stones into smaller pieces, which can be flushed out of the bladder with fluids and removed. Transurethral cystolitholapaxy is performed under local anesthesia or general anesthesia.
Why Is Transurethral Cystolitholapaxy Performed?
Bladder stones are lumps of hard minerals formed when the minerals in urine clump and crystallize to form stones in the bladder. These stones are formed if some volume of urine stays in the bladder after urination. Small stones pass in urine on their own. Large stones require surgical removal. If left untreated, bladder stones can grow in size and cause complications like frequent urination, pain during urination, and repeated urinary tract infections. Rare complications like vesicovaginal fistula may develop. Hence, it is essential to treat bladder stones. Transurethral cystolitholapaxy helps in removing bladder stones efficiently.
What Is the Difference Between Litholapaxy and Lithotripsy?
Lithotripsy refers to the action of breaking stones with shock waves. Litholapaxy refers to the process of breaking stones and removing them through a cystoscope. Litholapaxy removes stones with a crushing device, causing mechanical or physical destruction or using lasers. Lithopaxy is mainly performed for bladder stones. Lithotripsy can be performed in the bladder and kidneys.
What Are the Various Types of Cystolitholapaxy procedures?
Cystolitholapaxy procedure is of two types. It includes:
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Transurethral Cystolitholapaxy - Transurethral cystolitholapaxy can be performed under general or local anesthesia. A cystoscope is inserted into the urethra to reach the bladder, and the stones are removed by mechanical or physical destruction or lasers.
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Percutaneous Suprapubic Cystolitholapaxy - Percutaneous suprapubic cystolitholapaxy is performed in cases where transurethral cystolitholapaxy is not suitable and effective. This procedure requires general anesthesia. An incision of approximately 0.39 inch is made on the skin of the lower abdomen, and a hollow tube called a sheath is placed. The cystoscope is then inserted through the sheath to reach the bladder. The stones are then removed through the cystoscope. This procedure is usually preferred for treating bladder stones in children and for removing large bladder stones in adults. This is performed in children because of their narrow urethra, where it is difficult to insert the cystoscope.
What Are the Complications Associated With Transurethral Cystolitholapaxy?
Transurethral cystolitholapaxy causes complications like urinary tract infections, bleeding, and damage to internal tissues or structures. It can cause bladder tears or damage. Failure to completely remove all the stones is also a potent complication. Other complications, like delayed scar formation in the urethra, may occur.
What Is the Significance and Drawback of Transurethral Cystolitholapaxy?
Transurethral cystolitholapaxy is the classical treatment for bladder stones. It is performed with a cystoscope, lithotriptoscope, nephroscope, rectoscope, or ureteroscope. Other procedures like open cystolithotomy, percutaneous cystolitholapaxy, and extracorporeal shockwave lithotripsy are performed depending on the size of the bladder stones. However, transurethral cystolitholapaxy is time-consuming and has high morbidity because this procedure is associated with certain drawbacks. This includes the following:
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Bladder stone easily rolls within the bladder cavity, making lithotripsy difficult for hard and large-volume stones.
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Crushing large stones produces excessive fragments. Since the male urethra is slender and curled, litho extraction is difficult.
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The bladder wall is very thin and can be easily damaged, and multiple entries into the urethra cause urethral injury.
How Are Larger Bladder Stones Treated?
Surgical removal is performed for larger stones. The stones are stabilized with the jaw to prevent rolling in the bladder, and lithotripsy is performed efficiently. Stones that are fewer than 7 mm (millimeter) can be removed with the jaw through the outer sheath. This procedure does not require urethral entry and prevents urethral injury. Smaller fragments can be removed through the urethra. In advanced, elderly, high-risk patients, or large and hard stones, surgical treatment is performed in phases.
What to Expect With Transurethral Cystolitholapaxy?
The duration of the procedure depends on the number and size of the stones present. In severe cases, several rounds of this procedure may be necessary. A urinary catheter may be inserted to drain urine after the procedure. It may take one week to recover from cystolitholapaxy. Since it is a minimally invasive technique, postoperative pain is less, and recovery is faster. It is essential to consult the doctor if there is pain or burning sensation during urination, bleeding, difficulty in urination, or fever. A follow-up appointment one month after the procedure is mandatory. A radiographic study may be performed to ensure the complete removal of bladder stones. Another surgical procedure, like open cystotomy, is required if cystolitholapaxy remains unsuccessful. Bladder stones recur if the underlying cause is not treated. Hence, treating the underlying cause is also important in the management of bladder stones.
Conclusion
Various approaches are available for treating bladder stones, but transurethral cystolitholapaxy is the classical method that is safe and effective. It is a minimally invasive surgical technique. A recent advancement in this technique can accommodate pediatric urethra, and it is applicable for selected cases. Management of the underlying cause of bladder stone formation is also essential to prevent the recurrence.
