what are the risks of surgery to remove bladder stones
Cystoscopic Laser Lithotripsy and Stone Extraction (Cystolithalopaxy)
Stones occur within the urinary float due to incomplete bladder emptying, urinary stasis, and/or chronic bladder infections. With time, the urine that is not voided begins to harbor bacteria and contain higher amounts of fungus, sediment and urinary minerals, somewhen resulting in a bladder calculus.
Surgical options for patients with symptomatic bladder stones include open cystolithotomy, percutaneous cystolithotomy, or cystoscopic laser lithotripsy with stone extraction (cystolithalopaxy – meaning "a look into the bladder to beat a rock."). Your float/urethral beefcake, your bladder rock size, and body habitus all play major roles in determining outcomes and operative approach. Also, whether or not a prostate procedure is necessary at the time of stone removal is an of import consideration for men with enlarged prostates and bladder stones.
The part of cystolithalopaxy over the terminal ten years has undergone a dramatic evolution, due to the advent of holmium laser. Stone that were routinely removed using an open incision may now be cleaved into multiple smaller pieces and removed through a natural body opening (the urethra), avoiding both the pain and the recovery of an open incision.
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Prior to the Procedure
What to await during your initial consultation:
- Information technology is of import that prior to your initial clinic consultation thatall Xray films and their reports (e.g. CT scans, intravenous pyelogram or IVP, sonogram, or MRI) are compiled and brought to your appointment for careful review past your surgeon. These films can exist requested along with the radiology report from the facility that performed the Xray. A review of your medical history and a physical examination will exist performed along with blood and urine tests if needed. If your surgeon determines that you are a candidate for cystolithalopaxy, you volition and so run into with a Surgery Scheduling Coordinator to arrange for the date of your process.
What to expect prior to surgery:
- Once your surgery date is secured by one of our Surgery Scheduling Coordinators, the items listed below will be ordered every bit necessary based upon your historic period, medical history and run a risk for surgery. These will be performed through a preoperative anesthesia consultation at the Presurgical Centre at UF & Shands that will exist arranged for you at your initial visit. During this consultation you will have the opportunity to speak to the anesthesia staff regarding the types of anesthesia available and the risks/benefits.
- Physical examination
- EKG (electrocardiogram)
- CBC (consummate claret count)
- PT / PTT (claret coagulation profile)
- Comprehensive Metabolic Panel (blood chemical science profile)Urinalysis
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Grooming for surgery
Medications to Avoid Prior to Surgery:
- Patients undergoing cystolithalopaxy are recommended to discontinue all blood thinners prior to surgery, if medically possible. Please contact your surgeon's function if you are unsure about which medications to stop prior to surgery. The post-obit is a list of medications to avoid at least 7-x days prior to surgery. Many of these medications can alter platelet part or your body's ability to clot and therefore may contribute to unwanted bleeding during or after surgery. Do non stop any medication without contacting the prescribing medico to get their approval.
- Aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx, Plavix
- A formal listing of these medications and others volition be provided to you by our Surgery Scheduling Coordinators.
There is no bowel preparation needed for cystolithalopaxy, and nearly patients are asked to be NPO ("nil by mouth") afterwards midnight of the night prior to surgery.
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The Surgery
One time you are asleep, the surgeon passes a pocket-sized lighted tube (cystoscope), through the urethra and into the urinary bladder. Once the stone is located, it may be snared with a basket device and removed whole from the urethra. If the stone is large and/or if the diameter of the urethra is narrow, the stone is fragmented into multiple smaller pieces using a laser. These pieces are then irrigated and removed from the bladder through the urethra. In about cases, to ensure proper drainage, a urinary catheter (foley) is left in the float after the surgery for several days.
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Potential Risks and Complications
As with whatsoever major surgery, complications, although rare, may occur with cystolithalopaxy. Potential risks and complications with this operation include but are not limited to the following:
- Bladder spasm/hurting: Information technology is widely believed that the bladder heals faster post-operatively when decompressed than when continually filled with urine. Because of this, many patients are asked to keep a plastic urinary tube (foley) within the bladder following the process, allowing urine to pass at all times into a bag. The catheter is held in place by means of a plastic airship, about the size of a ping-pong ball. This airship "rubs" the lining of the bladder, resulting in bladder spasms (the feeling that ane needs to urinate despite an empty bladder) and discomfort. These spasms usually get better with time and float decompression, and there are also medications that can exist used to treat bladder spasms. Ask your surgeon about the potential need for a catheter post-obit your surgery.
- Secondary procedures:Almost patients who undergo cystolithalopaxy have a stone within their bladder for a reason – either chronic stasis of urine (not emptying their bladder well) or chronic infections. Removing a stone does not cure chronic stasis simply may aid the bladder empty better. Talk to your urologist nigh the chances of elimination better once the stone is removed and whether or not a procedure is necessary along with your cystolithalopaxy to help the float empty better.
- Stone fragments:Residual stones within the bladder is certainly a risk after cystolithalopaxy, and the risk is proportional to the size of the stone being removed. Inquire your urologist to give you some idea of success rates for your item rock size. Large stones may crave two surgeries, with the potential for three-4 hours during each surgery.
- Bladder perforation:The bladder is a adequately thick organ, and then complete perforation is very rare (0.1%) but mucosal tears and scrapes are inevitable. These all heal with time. Should a big perforation occur, your urologist may chose to stop the procedure and render on another day when the bladder has had time to heal. Should your urologist think the perforation of the bladder is in advice with your abdominal cavity, emergent open bladder surgery volition be necessary to shut the hole on the float using suture material. A catheter would be worn for several weeks until the bladder hole has had time to heal. This catheter temporarily diverts the urine away from the hole and out into a pocketbook until healing tin occur and the hole close.
- U rethral or ureteral injury: During stone fragment removal, stone fragments may cutting or tear the urethra. This is usually self-limiting but may occasionally event in urethral strictures (scar tissue within the urethra) or bleeding. Within the bladder are ii opening that bring urine downwardly from the kidney (ureter). Although unlikely, information technology is possible to injure the ureter by directly laser firing or by scope trauma. This rare effect usually requires a ureteral stent to facilitate ureteral healing.
- Hematuria and infection:Almost all patients run into blood in the urine for several days later on rock surgery. Urinary tract infection is as well certainly possible when the stone is broken as bacteria are released from the stone surface. These complications are ordinarily self-limiting and resolve with hydration and antibiotics, respectively.
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What to Await After Surgery
- Firsthand p ost-operative menses:Afterward the surgery you will be taken to the recovery room. If a urinary catheter (foley) was placed during surgery, it will likely stay in place for several days until its removal in clinic. Once your pain is controlled, you may be discharged from the recovery room to home. Expect blood in the urine for several days. With time and hydration, the urine should slowly turn from a watermelon reddish color to pinkish to clear. You may take foley balloon pain or float spasms (run across complications of cystolithalopaxy to a higher place) that can exist helped by overactive bladder. Due to instrumentation, most patients will receive 4-5 days of oral antibiotics to prevent a urinary tract infection.
- Postoperative Hurting: About patients subsequently cystolithalopaxy experience mild to moderate pain in the suprapubic area. This is mostly well controlled by use of oral narcotics (pain medication) such equally Percocet or Vicodin. Equally you get further out from your surgery, you may be able to decrease the strength of the medication to Extra Strength Tylenol or Motrin, as narcotics may cause constipation and sedation.
- Nausea:Nausea is adequately common following any surgery specially related to general anesthesia. This is ordinarily transient and is cocky-limiting. Should yous have excessive nausea and airsickness, you should contact your surgeon for advice.
- Showering: Patients can shower immediately upon discharge from the hospital
- Activity: Patients may begin driving once they are off all narcotic pain medication. Most patients are able to perform normal, daily activities within five-7 days after cystolithalopaxy. However, many patients describe more than fatigue and discomfort with a foley catheter in the bladder. This may limit the amount of activities that you lot can perform.
- Nutrition: Most patients simply desire clear liquids for the outset 24 hours following cystolithalopaxy, as your intestinal role may be sluggish due to the furnishings of surgery and general anesthesia. Following this period, patients may resume a regular diet as tolerated.
- Fatigue: Fatigue is quite common post-obit surgery and should subside in several days following surgery.
- Constipation/Gas Cramps: Y'all may feel sluggish bowels for several days following your cystolithalopaxy every bit a result of the anesthesia. Suppositories and stool softeners are normally given to help with this problem. Taking a teaspoon of mineral oil daily at abode will also help to prevent constipation. Narcotic hurting medication tin also cause constipation and therefore patients are encouraged to discontinue any narcotic pain medication as presently after surgery as tolerated.
- Follow-up Appointment: Patients should make a follow-up engagement with their surgeon by contacting the UF Health Medical Plaza Urology Clinic at 352.265.8240. Your surgeon will let you know the timing and schedule of clinic visits post-obit surgery.
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Oft Asked Questions (FAQs)
What are the advantages of cystolithalopaxy compared to other stone treatments?
- Cystolithalopaxy can treat most stones with the bladder, avoiding the incision of open surgery every bit well as the prolonged wearing of an indwelling catheter. Because it uses a natural torso opening, the healing time is sooner and the risk of infection is lessened.
Who is not a skilful candidate for cystolithalopaxy?
- Because cystolithalopaxy requires actively removing all rock fragments, the treatment of very large stones may yield so many fragments that complete removal becomes impractical or impossible. Besides, remember that every piece of bladder stone must be broken and come through the urethra, causing a potential for urethral strictures or scar tissue. Speak to your urologist about when to perform a cystolithalopaxy versus an open/percutaneous bladder stone removal.
What are the success rates of cystolithalopaxy?
- Depending on stone size, success rates vary anywhere from 60% – 100%. Ask your surgeon to talk over success rates tailored to your particular stone disease.
Do I need a prostate procedure in improver to my bladder rock removal?
- Many times, the presence of a bladder stone is a surrogate marking for bladder neck dysfunction, chronic infections, metabolic disorders, or prostate obstruction. For modern urologists, a wide array of prostate medications is bachelor to help patients empty subsequently bladder stone removal. All the same, many studies have documented the safety and efficacy of a combined prostate and float stone surgery. Inquire your md to talk over with you their feel with this type of combined procedure.
How long will my catheter stay in place?
- The length of time the catheter remains in your bladder is variable. Your doctor will probably request it to be removed somewhere betwixt ii – 10 days afterwards your procedure.
Following cystolithapaxy, when might it exist necessary to call a doctor?
- You should contact your urologist if the catheter is causing you abiding, unrelenting pain, if you have symptoms of a urinary tract infection (fever, rigours, feeling unwell and pain passing urine), or if your urine is nighttime red, similar to the color of tomato basil soup.
What alternatives are there to a foley catheter?
- Occasionally, it may be possible to place a tube externally that drains the bladder. This tube is placed directly through the skin and into the bladder, called a "suprapubic catheter." This is placed under directly vision using fluoroscopic Xray guidance at the fourth dimension of your surgery. As the tube remains exterior the body, it is slightly more than inconvenient, has higher infection rates, and can sometimes get pulled out by accident. The advantage of a suprapubic tube is better drainage, less urethral irritation, and ability to place contrast into the bladder to evaluate for obstruction or leakage. Also, should in that location be any question of urination after surgery, one may clamp the suprapubic tube for several days and allow the bladder to cycle/urinate during this time. After each urination, the tube may be unclamped and the amount of "postal service-void" residuum can be measured (similar to a pop-off valve). If it appears that the bladder is emptying, then the suprapubic tube tin be removed in clinic.
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Source: https://urology.ufl.edu/patient-care/stone-disease/procedures/cystoscopic-laser-lithotripsy-and-stone-extraction-cystolithalopaxy/
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