Once you are asleep, the surgeon passes a small 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 most cases, to ensure proper drainage, a urinary catheter (foley) is left in the bladder after the surgery for several days.
Potential Risks and Complications
As with any 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/pain: It 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 procedure, allowing urine to pass at all times into a bag. The catheter is held in place by means of a plastic balloon, about the size of a ping-pong ball. This balloon “rubs” the lining of the bladder, resulting in bladder spasms (the feeling that one needs to urine despite an empty bladder) and discomfort. These spasms usually get better with time and bladder decompression, and there are also medications that can be used to treat bladder spasms. Ask your surgeon about the potential need for a catheter following your surgery.
- Secondary procedures: Most 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 but may help the bladder empty better. Talk to your urologist about the chances of emptying better once the stone is removed and whether or not a procedure is necessary along with your cystolithalopaxy to help the bladder 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. Ask your urologist to give you some idea of success rates for your particular stone size. Large stones may require 2 surgeries, with the potential for 3-4 hours during each surgery.
- Bladder perforation: The bladder is a fairly thick organ, so complete perforation is very rare (0.1%) but mucosal tears and scrapes are inevitable. These all heal with time. Should a large perforation occur, your urologist may chose to stop the procedure and return on another day when the bladder has had time to heal. Should your urologist think the perforation of the bladder is in communication with your abdominal cavity, emergent open bladder surgery will be necessary to close the hole on the bladder 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 bag until healing can occur and the hole close.
- Urethral or ureteral injury: During stone fragment removal, stone fragments may cut or tear the urethra. This is usually self-limiting but may occasionally result in urethral strictures (scar tissue within the urethra) or bleeding. Within the bladder are two opening that bring urine down from the kidney (ureter). Although unlikely, it is possible to injure the ureter by direct laser firing or by scope trauma. This rare event usually requires a ureteral stent to facilitate ureteral healing.
- Hematuria and infection: Almost all patients see blood in the urine for several days after stone surgery. Urinary tract infection is also certainly possible when the stone is broken as bacteria are released from the stone surface. These complications are usually self-limiting and resolve with hydration and antibiotics, respectively.