Cysto-Lithotomy

Why is it done?

• To break up a large bladder calculus (stone) that cannot be done endoscopically.
• It is done with open surgery (a cut above the pubic symphysis).

Risk factors causing this:

• • Bladder outflow obstruction
    • BPH with chronic retention.
    • Urethral stricture.
    • Neurogenic bladder.
  • Renal calculi disease.
  • Metabolic disorders.
  • Malnutrition.
  • Chronic infections.
  • Foreign objects in bladder.

How is it done?

• A General anesthetic will be given.
• A sterile surgical field is prepared.
• Prophylactic antibiotics are given.
• An indwelling catheter is inserted, and the bladder is then distended with fluid (saline).
• A small lower abdominal incision is made, splitting the Linea alba and opening the distended bladder in the midline.
• The stone is removed through the whole with a grasping instrument.
• The bladder is inspected and then closed in 2 layers.
• Skin is closed.
• A catheter will be left for 2 weeks.

What to expect after the procedure?

• Hematuria (blood in your urine)
• You will have an indwelling catheter (IDC), which will remain in your bladder.
• You may have a continuous bladder irrigation with Saline to help clear the bleeding.
• When your urine is clear and your bowels are functioning, you will be discharged with catheter care instruction.
• You will have this indwelling catheter for 2 weeks.
• A cystogram will be arranged at approx. 14 days to exclude any urine leaks prior to removal of your catheter.
• If there are any urine leaks, your catheter will remain a further 7 days, or until the leak is sealed.
• Pain on initial passing of urine when the catheter is removed.
• Bladder infection ranging from a burning sensation to, fever, to puss (rare).
• Lower abdominal discomfort which will persist for a few days.
• NB! Each person is unique and for this reason symptoms vary.

What next?

• This all depends on what is found during the procedure. All the options will be discussed in detail.
• There may be some blood in the urine. This can be remedied by drinking plenty of fluids until it clears.
• Anatomical causes of the stones will be discussed and surgical options in treatment may be discussed
• Patients should schedule a follow-up appointment within 4-6 weeks to discuss the etiology of the calculus as well as what other procedures may be involved to prevent this from occurring again.

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