Cystolithotripsy is a minimally invasive procedure used to treat bladder stones, which are hard masses of minerals that form in the bladder. The procedure involves breaking up the stones into smaller fragments that can be removed or passed out of the body through the urine. Cystolithotripsy is often preferred over open surgery because it is less invasive and has a quicker recovery time.

Types of Cystolithotripsy:

1. Transurethral Cystolithotripsy (CLT)

   • Procedure: A cystoscope (a thin, flexible tube with a camera and light) is inserted through the urethra into the bladder. A lithotripter device is then used to break the stones into smaller pieces. This can be done using mechanical, ultrasonic, or laser energy. The fragments are then either removed with a grasping device or allowed to pass naturally through the urine.

2. Percutaneous Cystolithotripsy (PCCL):

   • Procedure: This technique involves making a small incision in the lower abdomen to access the bladder directly. A nephroscope (a thin, flexible instrument) is inserted through this incision to locate and break the stones using similar lithotripter technologies. This method is typically used for larger stones or when transurethral access is not feasible.

Indications for Cystolithotripsy:

• Bladder Stones: When stones are too large to pass naturally or cause symptoms such as pain, urinary obstruction, hematuria (blood in urine), or recurrent urinary tract infections.

• Prostatic Obstruction: Stones that develop due to urinary retention caused by benign prostatic hyperplasia (BPH).

• Neurogenic Bladder: Stones that form due to incomplete bladder emptying in patients with neurological conditions affecting bladder function.

Procedure Overview:

1. Anesthesia: The procedure is typically performed under general or spinal anesthesia.

2. Stone Fragmentation: The stones are visualized using the cystoscope, and the lithotripter device is used to break them into smaller, more manageable pieces.

3. Removal: The fragments are either removed using a grasper or left to pass naturally through the urinary system.

4. Post-Procedure: A catheter may be placed temporarily to help drain the bladder and reduce irritation.

Benefits of Cystolithotripsy:

• Minimally Invasive: No large incisions are needed, resulting in less pain and faster recovery.

• High Success Rate: Effective in breaking up and removing bladder stones, especially when using advanced lithotripter technologies.

• Short Hospital Stay: Most patients can go home the same day or after an overnight stay.

Risks and Complications:

• Infection: As with any procedure involving the urinary tract, there is a risk of urinary tract infection.

• Bleeding: Minor bleeding may occur, but it is generally minimal.

• Urethral Injury: Rarely, the urethra may be injured during the insertion of instruments.

Cystolithotripsy is a highly effective and relatively low-risk procedure, especially when performed by a skilled urologist like Dr. Saurabh Mishra. It offers patients relief from the symptoms associated with bladder stones and helps prevent complications such as recurrent infections or urinary retention.

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