Open Cysto-Lithotomy

Why is it done?

• To break up a large bladder calculus (stone) that cannot be done endoscopically.

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.

Pre-requirements

• • • An informed consent is required from the patient.
    • Female patients should confirm that they are not pregnant.
    • Patients may not eat or drink from midnight the previous evening.
    • Patients are to refrain from smoking before the procedure.
    • Patients allergic to IODINE / CHLORHEXIDINE should clearly state this to theatre staff and to Dr Schoeman.
    • Patients with cardiac illnesses require a Cardiologist/ Physician’s report.
    • A chest X-ray is required for patients with lung disease.
    • Where required, Pre-Op blood tests are required 4 days before the procedure.
    • This is a day surgery procedure, unless more involved pathology is suspected or found during the procedure.

How is it done?

• • • A General anaesthetic 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 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 a n 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 indweliing 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.
  • A ward prescription will be issued to patients on discharge, for own collection at any pharmacy.
  • Anatomical causes of the stones will be discussed and surgical options in treatment may be discussed, i.e. TURP, ISC etc.
  • Patients should schedule a follow-up appointment within 1 month to discuss the etiology of the calculus as well as what other procedures may be involved to prevent this from occurring again.
  • Please don’t hesitate to direct all further queries to Dr Schoeman.

Download Information Sheet

Cysto-Lithotomy Open