What is Cystolithotripsy? - Procedure, Surgery, Risks & Recovery


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Cystolithotripsy is a minimally invasive surgical procedure used to treat all types of urinary bladder stones except very large ones that are hard to break. In this procedure, a surgeon uses an instrument called a ‘lithotripter’ to break and remove the stones from the bladder. 

This article discusses important details about cystolithotripsy, such as how the procedure is performed, what to expect before the procedure, and how long it takes to recover after the surgery. 
Surgery Name Cystolithotripsy 
Alternative Name Bladder stone removal surgery
Diseases Treated Urinary Bladder Stone
Benefits Highly effective treatment, Minimally Invasive
Treated By  Urologist

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What is Cystolithotripsy?

It is an endoscopic surgery performed to crush a urinary bladder stone into smaller pieces and remove it from the body. It is a safe and quick procedure for treating all types of bladder calculi (stones). 

Anatomy and Physiology of the Urinary System 

The urinary system comprises the following organs:
  1. Kidneys
  2. Renal Pelvis
  3. Ureters
  4. Bladder 
  5. Urethra
These organs work together to purify the blood by filtering out waste and toxic products to produce urine as the end product. The working of the urine system is explained in the following steps:
  1. After metabolism (the process in which the body converts food into energy), the body absorbs all the useful ingredients so that only waste and toxins remain in the blood and the bowel (a tube-shaped organ present in the lower part of the digestive system that goes from the stomach to the anus)
  2. The kidneys and the urinary system eliminate the waste and toxins (urea) from the blood to maintain its equilibrium of salt, potassium, and water. 
  3. When the kidneys filter the blood, urine is formed as the end product. 
  4. Once the urine is formed, it travels down to the bladder through the ureters (tubular structures that the kidneys to the bladder)
  5. The bladder walls relax and expand to store urine. When these walls contract, the urine is expelled from the body. 
  6. But certain medical conditions may prevent the bladder from emptying completely, and as a result, a small amount of urine remains inside the bladder. 

How Does a Bladder Stone Form? 

Urine contains several salts and minerals the body doesn’t absorb from food. The body expels these minerals with urine. Sometimes, a small amount of urine may be left in the bladder even after peeing. Over time, the minerals in the urine can get concentrated and crystallizes to form a urinary bladder stone.  

Conditions treated by Cystolithotripsy

Cystolithotripsy is performed to treat almost all types of bladder stones. However, in cases of very large or rigid stones that are resistant to the endoscopic approach, cystolithotripsy may not prove to be effective.

Who needs Cystolithotripsy?

There are several endoscopic procedures that are used to remove urinary bladder stones. Among these, cystolithotripsy is an effective treatment approach, especially for removing small bladder stones. The right candidates for cystolithotripsy can be the individuals who have:
  1. A blockage in the urinary tract due to bladder calculi (stone)
  2. Urinary tract infection - which may be caused due to a bladder stone
  3. Bladder stone symptoms include painful and interrupted urination, small blood in the urine, cloudy urine, etc. 
  4. Enlarged prostate and undergoing other obstruction treatments, such as TUR-P or optical urethrotomy. 

Who are not the Right Candidates for Cystolithotripsy? 

Cystolithotripsy may not be effective or can even cause harm to patients who:
  1. Are pregnant 
  2. Have bleeding disorders or are on blood thinning medications, such as Aspirin (the patient must prevent the use of medications for at least a week before the procedure)
  3. Have injured or scarred ureters that may prevent the stone fragments from passing 
  4. Have bladder stones composed of cystine and other types of calcium, as these stones may not be broken by lithotripsy

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How is Cystolithotripsy performed?

A urologist performs the cystolithotripsy procedure. Usually, it takes about 30 to 45 minutes to remove the bladder stone. However, this procedure can also be completed as soon as five minutes. So, the duration of the procedure may vary depending on the size and location of the stone. The procedure may involve the following steps:
  1. At first, the patient is placed in a gynaecological examination position (in a supine position but with knees bent and feet placed at the corners of the table). 
  2. The health care providers clean the crotch area and lubricate the urethra. 
  3. Once the urethra is lubricated, an instrument called a lithotripter is inserted inside the bladder through the urethra. The lithotripter provides a non-invasive approach (without making an incision) to treat the bladder stone. 
  4. During the procedure, ultrasound or fluoroscopy is used to identify the size and location of the stone. 
  5. Then a sequence of shock waves is sent through the lithotripter to break the stone into smaller pieces that can be easily removed from the body. 
  6. Finally, a catheter is placed inside the bladder to help the stone fragments pass out of the body. 
  7. In the case of hematuria (blood in the urine), continuous bladder irrigation is required till the blood clears up from the urine. 
  8. If the stone fragments are not small enough to pass from the urinary system, the procedure may be repeated to break them further so they can easily pass. 
The most commonly used lithotripters are: 
  1. Ballistic lithotripters use a controlled burst of compressed air to break even the hardest calculi.  
  2. Electrohydraulic lithotripters use high electrical voltage sparks to break the stones. 
  3. Laser lithotripters use a laser beam to crush the stone located in the urinary tract. 

What to expect before and on the day of Cystolithoscopy?

Before the cystolithoscopy, the doctor/surgeon will discuss and prepare the patient for the surgery. These steps often involve:

Before Cystolithoscopy 

One can expect the following things before the surgery:
  1. The doctor explains the procedure in detail, along with its risks and benefits. The patient can also ask any questions or doubts regarding his or her medical condition or the procedure. 
  2. After discussing all the details, the patient signs a consent form to permit the doctors to start the procedure.
  3. The patient must tell the doctor about his or her medical history. In addition, the doctor may also perform a physical exam to check if the patient is in good health. 
  4. Blood tests, chest X-rays, and other diagnostic tests may also be required before starting the procedure. 
  5. If the patient is pregnant, she must inform the doctor about her condition.  
  6. If the patient is taking anticoagulants (blood-thinning medications like Aspirin), he or she may need to stop taking these if the doctor instructs.  
  7. Fasting before the procedure may be necessary, depending on the anaesthesia used. 

Types of Anaesthesia Used in Cystolithotripsy 

Cystolithotripsy can be performed under local, spinal, or general anaesthesia, depending on the size and location of the stone. 
  1. Local anaesthesia is induced to numb a part or region of the body where the operation is performed. 
  2. Spinal anaesthesia is induced in the lower back (intrathecal space), where the cerebrospinal fluid is present. This fluid surrounds the spinal cord and is used to numb the lower abdominal region. 
  3. General Anaesthesia is given to render the patient unconscious or sleepy so that they don’t feel any pain during the operation.

On the day of Cystolithoscopy 

One can expect the following things on the day of surgery:
  1. The patient is asked to remove jewellery or any other accessories that may interfere with the procedure. 
  2. He or she is made to change into a hospital gown and be taken to the operating room. An IV line is started in the patient's arm to supply medications and IV fluids. 
  3. After placing the patient in a gynaecological examination position, shockwaves are sent to break the stone into fragments so that it can easily pass through the urinary system.
  4. Finally, a catheter is placed inside the bladder to remove the residual stone fragments from the bladder. 

What to expect after Cystolithotripsy?

Cystolithotripsy may be an inpatient or outpatient procedure, depending on the patient’s health condition after the process. He or she may expect the following things after the procedure: 

The recovery process at the hospital

  1. The patient is shifted to the recovery or hospital room.
  2. The catheter inserted during the procedure is removed as soon as the blood clears up from the urine (usually, it is removed after 6 to 8 hours of the procedure).
  3. If they are stable after the procedure, the doctor allows the patient to go home. If not, the patient may need to stay in the hospital for 1 to 2 days until recovery. 
  4. The doctor may prescribe pain-relieving medications and give instructions to drink more water and fluids to pass the urine without discomfort. 

Recovery process/expectation after hospital discharge

  1. The patient may notice a small amount of blood in the urine for a few days after the procedure.
  2. Pain and burning sensation in the urethra is also standard. The patient must take prescribed medications only to manage the pain. Aspirin and other pain relievers may increase the chance of bleeding.  
  3. If small fragments of stones were left in the bladder, they might pass out with urine the following days after the procedure. The doctor may also instruct to strain the urine to collect the stones for examination. 
  4. The patient may feel pain and discomfort while peeing for a few days after the procedure. But may recover from the pain and resume work within 2-3 days following the process. 
  5. If the catheter is not removed, the patient may experience intense pain and bladder spasms that last for a few seconds but return regularly. These symptoms can be improved with prescribed medicines till the catheter is removed. 
  1. Don’t engage in strenuous physical activities till the doctor allows it.
  2. Smoking, drinking coffee, and alcohol must be avoided, as these may irritate the bladder. 

First follow-up appointment

  1. The first follow-up appointment is scheduled a few weeks after the procedure. During the visit, the doctor examines the patient’s health condition. If a catheter is still placed inside the bladder, it is removed during the visit. 
  2. After removing the catheter, the doctor may check the urination mechanism of the patient with an ultrasound to ensure that the bladder empties after peeing. 

Benefits of Cystolithotripsy

Cystolithotripsy is a non-surgical means to treat urinary bladder stones. It has the following benefits:
  1. Cystolithotripsy is considered a highly effective treatment approach with a success rate of 60 to 100%, depending on the size of the stone. 
  2. It is considered safe as no cuts or incisions are required to carry out the procedure. 

Risks and complications of Cystolithotripsy

Although cystolithotripsy is a safe procedure for bladder stone removal, it may have a risk of the following complications:
  1. Urinary tract infection 
  2. Blockage in the urine flow if the stone fragments obstruct the urinary tract 
  3. Residues of stone fragments remaining after the surgery, requiring another cystolithotripsy

When is consultation with the doctor needed?

The patient must immediately consult their doctor if he/she is experiencing the following symptoms:
  1. Fever or chills
  2. Increased pain, redness, and swelling around the incision site
  3. Bleeding or drainage from the incision site

Risks of delayed Cystolithotripsy

If a bladder stone remains untreated for a long time,
  1. It may grow large by accumulating more minerals over time. Endoscopic procedures may not effectively treat large stones, so the patient may require open surgery to get relief. 
  2. Small untreated stones can move from the bladder and obstruct the passage of urine flow. This can lead to the risk of repeated urinary tract infections.
  3. Blockage in the urine flow may also cause urine to pool inside the bladder leading to the risk of developing more bladder stones. 

Cost of Cystolithotripsy

The estimated cost of cystolithotripsy in India is ₹1,10,000 to ₹2,40,000. However, the prices may be different depending on the chosen city and the patient’s medical condition. The cost varies based on the following factors:
  1. Age of the patient
  2. The type of technique used
  3. The medical condition of the patient
  4. The type of hospital facility availed - individual room or shared.
Procedure Name Cost Value
Cystolithotripsy ₹1,10,000 to ₹2,40,000

Frequently Asked Questions (FAQ)

  1. Myth: Eating tomatoes and other seeded vegetables can cause bladder stones. 
    Fact: This is not true. Tomatoes and other seeded vegetables, such as lady finger, cucumber, and green pepper, don’t cause bladder stones if eaten in normal quantities. However, when the blood potassium level is too high, the patient may need to avoid eating tomatoes and other seeded vegetables. 
  2. Myth:  Reducing calcium intake can help in preventing urinary stones. 
    Fact: This is not true. As calcium is one of the major components of kidney/bladder stones, it is often believed that restricting calcium in the diet can help in the prevention of the stone. However, this is not the case. Studies show that reducing calcium intake can increase the occurrence of bladder stones as it can increase the absorption of oxalate from the intestines. So, the consumption of calcium should not be restricted. 
  3. Myth: Medicines cannot dissolve a urinary bladder stone. 
    Fact: As most urinary stones are composed of hard compounds, such as calcium oxalate or calcium phosphate, it may seem that no medicine can dissolve these stones. But this is not true. In patients with small stones, medicines can prove to be effective in dissolving the stones. 
Cystolithotripsy is a safe and effective treatment approach for bladder stone removal. In this method, shockwaves are sent through an instrument called a lithotripter inside the bladder to crush the stone into smaller pieces so they can easily be expelled from the body.  
Small bladder stones usually pass out of the body naturally. But if the stone is larger than 0.5 centimetres, surgery may be required for its removal. 
Bladder stone removal can be done using minimally invasive endoscopic procedures. In some cases, surgery may be required if the stone is very large or located in a place that is difficult to reach through endoscopic procedures. But, in all the procedures, general or spinal anaesthesia is given so the patient doesn’t feel any pain or discomfort. 
Lithoplaxy is the procedure of crushing a urinary bladder stone into smaller pieces to remove it through a catheter easily. 
Although cystolithotripsy and cystolithoplaxy seem similar in their approach, as both techniques are used to break the stone into small fragments and remove it from the body, they have a small difference. 
In lithotripsy, electric shock waves are sent through an instrument (lithotripter) to break the stone. In contrast, lithoplaxy uses a catheter to pass a laser beam needle to crush the stone into smaller pieces.
At first, general or spinal anaesthesia is induced, and the patient is placed in a gynaecological examination position to get direct access to the stone. The location of the stone is identified through ultrasound, and an instrument called a lithotripter is inserted inside the bladder through the urethra. Finally, shock waves are sent through the instrument to crush the stone into smaller pieces and remove them from the body. 
In medical terms, bladder stones are also known as bladder calculi. 
After cystolithotripsy is performed, a catheter is placed inside the bladder to flush out the remaining stone fragments. If blood is noticeable in the urine, the catheter helps irrigate the bladder till the blood clears up from the urine. The catheter is usually removed 6-8 after the surgery, but in some cases, it may need to remain in place for a few days or weeks, depending on the patient’s health condition. 
Drinking plenty of water may help flush out small bladder stones naturally. Besides water, citrus fluids, such as lemonade and orange juice, can also help dissolve the stone. 
If large bladder stones remain untreated for a long time, they can cause chronic irritation to the bladder walls. This is why they are a possible risk factor for squamous cell carcinoma (cancer in the squamous cells present in the outer layer of the skin and other body parts, such as the digestive tract and urinary tract). Timely diagnosis and removal of the stone are necessary to avoid such risks. 
Untreated bladder stones can lead to several urinary problems, such as:
  1. Severe pain in the abdomen 
  2. Frequent urination 
  3. Interrupted and painful urination 
  4. Urinary tract infection 
  5. Chronic damage to the bladder and kidneys
Cystolithotripsy involves the risk of the following complications:
  1. Urinary tract infection 
  2. Blockage in the urine flow if the stone fragments obstruct the urinary tract 
  3. Residues of stone fragments remaining after the surgery, requiring another cystolithotripsy
Urinary bladder stones are not life-threatening, but if they do not pass out naturally or are left untreated, they may increase the risk of repeated urinary tract infections. Over time, these stones can also cause permanent damage to the kidney and the bladder. 

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