Transurethral Cystolitholapaxy Surgery in Bhagalpur

Cystolitholapaxy is a surgical procedure in which stones in the urinary bladder are broken down into smaller pieces. When during cystolitholapaxy, a cystoscope is passed through the urethra, it is called transurethral Cystolitolapaxy. Urethra is a tube that connects the urinary bladder to an opening outside the body from which the urine is passed out in males and females.

Different techniques can remove stones in the kidney and ureter, but Transurethral Cystolitholapaxy is the treatment of choice for stones in the bladder. This non-invasive procedure is performed on an outpatient basis, meaning you can go home the same day. 

Transurethral Cystolitholapaxy is done by introducing a cystoscope (??a thin tube with an attached lens, a video camera, and a light at the end) through your urethra and into your bladder to locate the stones.

A laser is then used to break down the stones too large to be expelled out of your body on their own. It is a preferred procedure that can be done under general or spinal anesthesia.

Stones (Calculi) are more commonly present in the urinary tract and can form anywhere from the bladder or kidney. Stones in the kidney are hard masses of different compositions that are formed from crystals in the urine. Calcium stones are the most common type of kidney stones. 

Other types include uric acid stones, struvite, and cystine stones. The size of the stone varies from being small gravel-like to larger stones like staghorn (like the antlers of the deer, filling the renal pelvis and calyces) calculi. 

These stones can cause symptoms like pain in the flanks, abdomen, lower groin, or back, blood in urine, nausea, vomiting, etc. When these stones become big and block the passage of urine or cause infection, they can damage the kidneys. 

Transurethral Cystolitholapaxy removes stones in the bladder in adults when they cannot pass stones naturally by drinking water. It is recommended if you do not want to go under the knife for stone removal (you do not want any incisions for stone removal)

Before undergoing surgery, it is important to prepare for it. Your urologist will take a detailed history of your symptoms and discuss further action.

Before Surgery: 

• Your surgeon will perform some tests to confirm the presence and size of bladder stones, which include:
  • Ultrasound of the kidney, ureter, and bladder (KUB). This is a test in which high-frequency sound waves capture live images in your body. It helps to show the presence of stones in the urinary tract.
  • CT scan (Computed tomography scan). This is also known as a CAT scan (computed axial tomography scan) that uses a combination of computers and X-rays to see images of your body. This is more accurate in diagnosing kidney stones.
  • Routine urine analysis- To check for any bacterial urinary tract infections.
  • Urine cytology- This test will examine your urine microscopically to check for abnormal cells since the cancer cells related to kidney tumors are most often shed in the urine.
  • Blood test- A complete blood count may be advised to check your overall health. Also, these may indicate high levels of any substances in the blood, e.g., if you have uric acid stones, you will have high uric acid levels.
  • RFT (Renal Function Test)- This blood test evaluates your blood urea nitrogen (BUN) and creatinine levels.
• You will be advised to do routine hemoglobin levels, blood group, liver and kidney function tests, chest X-rays, and electrocardiograms (ECG) to assess your overall condition before the procedure.
• You will be advised to:
  • Avoid the medications like blood thinners for at least 2 weeks before the procedure to minimize the risk of bleeding.
  • Avoid smoking and alcohol for 2 weeks pre-procedure to prevent delayed wound healing.
  • Be on a liquid diet 24 hours before the procedure and fast after midnight.
• You would be asked to wear loose-fitting and comfortable clothes on the day of your surgery.
• You will have to arrange for a family member to drive you home as you cannot drive due to the effects of anesthesia.

Transurethral Cystolitholapaxy is a safe and noninvasive procedure performed by a skilled urologist (a doctor specializing in urinary tract diseases and male reproductive system disorders). The procedure normally takes 30 to 60 minutes but may take longer, depending on the number and size of the stones. 

It can be done under general anesthesia (you will be asleep during the procedure and will feel no pain) or spinal anesthesia (anesthetic is injected in the spinal fluid to numb the lower part of your body; you will be awake during the procedure but not be able to move your lower body and will not feel the pain). 

During Surgery:

• On the day of the surgery, you will be asked to sign a consent form that allows the surgeon to perform the procedure on you. 
• Your vitals will be checked, and a line will be administered for intravenous (IV) anesthesia and antibiotics.
• A urinary catheter will be placed to drain the urine.
• Once taken to the operating room, the surgical site will be cleansed with an antiseptic solution.
• General/ spinal anesthesia will be administered. 
• You will be made to lie with your legs spread apart and flexed at the knee, and your legs will be supported on the stirrups (lithotomy position).
• Once the anesthesia sets in, your surgeon will introduce a cystoscope (a small rigid tube with a camera at its end) into the bladder through the urethra and t visualize the inner surface of the bladder and the stone (s). The camera helps in locating the stones.
• The surgeon then uses a crushing device, lasers, ultrasound waves, or a jaw-like instrument that is inserted through the cystoscope) to break the stone into smaller fragments.
• Some smaller fragments can be grasped with the instrument and removed via the cystoscope. The remaining fragments can be removed during irrigation and suction of the bladder.
• The larger fragments are collected and sent to the laboratory for examination.
• The cystoscope is removed, and the urinary catheter is kept in place to drain the urine for a few days.

After a Transurethral Cystolitholapaxy, you will be observed in a PACU (post-anesthesia care unit), to monitor your vitals (blood pressure, pulse rate, temperature, respiratory rate, heart rate) closely. The catheter will be removed 24 to 48 hours later.

After Surgery: 

• You will be made to ambulate to prevent the formation of blood clots. 
• You will have a burning sensation while urinating and may notice blood in the urine for a week after the procedure. This will be expected and is due to the cystoscope that was inserted. Your surgeon will prescribe antibiotics to ward off the infection and painkillers for pain relief. 
• As it is an outpatient procedure, you will be sent home with the catheter in the urethra after your vitals are stable and the effect of anesthesia has worn off. 

Your surgeon will provide you with instructions to follow at home:

• You will be allowed to bathe after the catheter has been removed.
• You will be advised to drink clear liquids for the first 24 hours after the procedure to prevent nausea and vomiting due to the effect of anesthesia. You can resume your normal diet from the next day. You should eat lots of veggies and fruits and include fiber to prevent constipation.
• Keep yourself hydrated by drinking 1.5 to 2 liters of water daily.
• You would be advised to start walking to prevent the development of clots. You will be allowed to do mild exercises and climb stairs. You can resume your normal routine 5 to 7 days after the procedure.
• You should not lift heavy weights, exercise strenuously, or indulge in sexual activities until your surgeon advises. You can start driving the next day.
• You can resume work 2 to 3 days after the procedure if you have a desk job. If your job requires physical labor, waiting 1 to 2 weeks to resume work is important.
• Your surgeon will schedule a follow-up appointment 2 to 3 days after the procedure to remove your catheter and then 4 to 6 weeks later to check by imaging tests whether the bladder stones have been completely removed.
• Complete recovery takes about 1 to 2 weeks.

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