Cystolithotripsy Surgery: An Overview

Cystolithotripsy commonly breaks down bladder stones into smaller components, facilitating their easier removal from the bladder. Bladder stones develop when minerals in the urine crystallize, often due to urinary tract infections, an enlarged prostate, or prolonged catheterization. Cystolithotripsy is a non-invasive surgery that effectively removes bladder stones while maintaining normal urinary function.

Types of Cystolithotripsy Surgery

According to the size and composition of the bladder stones, cystolithotripsy is performed using different techniques such as:

1. Transurethral Cystolithotripsy (Endoscopic)—A cystoscope is introduced through the urethra to break stones by a laser or ultrasonic waves.

2. Percutaneous Cystolithotripsy—This procedure creates a small incision in the lower bowel with direct access to the bladder to fragment the stones.

3. Extracorporeal Shockwave Lithotripsy (ESWL)—This technique uses high-energy shock waves projected from the outside of the body to break stones into tiny particles.

Symptoms of Bladder Stones

The symptoms of bladder stones can sometimes go unnoticed. However, common symptoms that could appear include

o Increased frequency of urination

o Pain or burning while urinating

o Lower pain in the abdomen

o Hematuria (blood in the urine)

o A dark or cloudy color of the urine

o Problem during urination or interrupted urine flow

o Infections that lead to fever and chills

Diagnosis of Bladder Stones

Before cystolithotripsy is carried out well, one aims to achieve a unique diagnosis:

• Urinalysis: Infection, blood, and crystals in the urine

• Ultrasound: It reveals the bladder's stones.

• The X-ray (KUB—Kidney, Ureter, and Bladder) shows radio-opaque stones.

• For stone detection, a CT scan provides a detailed image of the urinary system.

• Cystoscopy—A thin, flexible camera is directed through the urethra to directly scrutinize the bladder.

Causes of Bladder Stones

Irrespective of the cause, bladder stones mostly evolve due to the following:

• Retention of urine—A patient fails to empty the bladder completely.

• Enlargement of the prostate gland (BPH) tends to block the urine outflow for men.

• Neurogenic Bladder—This is nerve damage affecting the control of the bladder.

• Foreign bodies in the bladder—Includes catheters or stents.

• Chronic urinary tract infections—They usually bring about mineral formation.

• Dehydration—Concentrated urine promotes the formation of crystals.

• Diet-related factors - Excessive intake of oxalate or calcium-rich foods

Risks and Complications

Although effective methods include the process, it can still carry the following risks:

• Infection from contact with the bacteria.

• Bleeding occurs when there is an injury to the bladder or urethra.

• Perforation of the bladder walls occurs.

• Urinary retention caused by swelling or clots.

• The remnants of stone necessitate an additional procedure.

•  The urethra narrows during post-surgery urethral handling.

Preparation for Cystolithotripsy Surgery

There should be proper preparation for a smoother surgical experience and recovery. Through:

• Preoperative tests—blood tests, urine analysis, and imaging studies

• Medication adjustment—stopping blood thinners similar to the case of aspirin

• Hydration—drinking beneficial quantities of liquid before surgery

• Fasting—keeping away from food and drink for at least 6 to 8 hours if for elective general anesthesia.

• Bladder Emptying—this might involve catheterization preparation for surgery.

Procedure for Cystolithotripsy Surgery

The surgical approach taken will depend on the technique used:

1. Administration of anesthesia—This includes giving a local, spinal, or general anesthetic.

2. Insertion of cystoscope—a thin tube in which a camera is attached that is to be put in the bladder.

3. Fragmentation of stones—Depending on the technique:

    o Laser Lithotripsy—Whereby beams are used to break the stones into smaller parts.

    o Ultrasound Lithotripsy—This method differs from others because it uses a high enough frequency of waves to destroy kidney stones.

    o  Mechanical Lithotripsy—It involves the manual disintegration and removal of stones.

4. Irrigation and removal—removing the debris from the bladder.

5. Positioning of the catheter: It will leave a urethral catheter as a drainage for a short time.

6. Closure and recovery: Cooperation for improvement post-surgery.

Recovery

Cystolithotripsy surgical recovery is dependent on the individual's health and the severity of procedure. General stay guidelines include:

• Hospital Stay—Most discharge patients on the same day or after 24 hours.

• Hydration—Generally helps flush the remaining stone fragments by drinking plenty of fluids.

• Pain Management—Prescribed analgesics help relieve the discomfort.

• Urination Monitoring—It is fairly normal at the outset for there to be some blood in the urine.

• Heavy Activity—No strenuous activities for weeks.

• Follow-Up Visits—Regular visits to the doctor to ascertain that there are no stones left.

Clinical trials

Research is ongoing with innumerable clinical trials, which aim to improve outcomes in cystolithotripsy. These clinical trials include:

• We are developing faster stone fragmentation with new laser applications.

• Non-invasive methods of removal.

• Drugs to prevent recurrences of stones.

• Enhanced imaging modalities for specifically accurate diagnosis.

Side Effects

After an operation, you may experience the following side effects:

• Some mild burning sensation can develop during urination.

• Transient hematuria.

• A temporary loss of bladder control may occur.

• Bladder spasms with mild discomfort.

Success Rate of Cystolithotripsy Treatment

Cystolithotripsies have a high success rate, and more than 90% of patients suffering from them are completely stone-free, but the outcome depends on the size and composition of the stone as well as post-operative compliance.

Diet to follow after treatment

A balanced diet protects against stone reformation. Some dietary recommendations include:

• INCREASED FLUID: 2-3 liters of water daily.

• Low Sodium Diet: It reduces mineral buildup.

• Avoiding oxalate-rich foods, such as spinach, nuts, and tea.

• A calcium-enriched diet prevents oxalate stones.

• Citrus, like lemon and orange juices, minimizes stone formation.

• Protein Moderation: Some extra animal protein may further add to stone formation.

The Cost of Cystolithotripsy Surgery in India

It varies with respect to the facilities of the hospital, qualifications of the surgeon, and procedure type. Average costs are: Government Hospitals: 20,000-40,000 Private Hospitals: 50,000-150,000 Laser Lithotripsy: 80,000-200,000 Many insurance policies will cover cystolithotripsy to an extent.

Conclusion

Bladder stones can be treated effectively by cystolithotripsy. This procedure is minimally invasive, proven to be safe, has a high success rate, and has minimal complications. It is, therefore, the most preferred option for doctors when treating bladder stones. Early diagnosis, appropriate dietary modifications, and regular monitoring are vital for prevention of reoccurrence and hence long-term urinary health.