Cystolitholapaxy

A cystolitholapaxy is a procedure to remove bladder stones. Surgeons use an instrument called a cystoscope to locate the stone or stones. A laser crushes the stones into smaller pieces so your surgeon can remove them.

Overview

What is a cystolitholapaxy?

A cystolitholapaxy is a surgical procedure that treats bladder stones, which are hard deposits of minerals that can form inside your bladder. During a cystolitholapaxy, a surgeon inserts an instrument called a cystoscope into your bladder to locate the stone or stones. A cystoscope is a tube with a camera on the end. A laser then breaks up the bladder stones into smaller pieces, which your surgeon then removes.

The procedure is outpatient, which means you go home the same day you have surgery. Surgeons perform it using local or general anesthesia.

  • What are the types of cystolitholapaxy procedures?

There are two different cystolitholapaxy procedures:

  • Transurethral cystolitholapaxy: This is the surgical procedure healthcare providers use most often to treat bladder stones and the procedure most are referring to when they say cystolitholapaxy. A provider inserts a cystoscope into your urethra and bladder to see the stones. Then, they use a laser or other ultrasound device to break the stones into small pieces for removal.
  • Percutaneous suprapubic cystolitholapaxy: Healthcare providers use this method when treating children with bladder stones because their urethras are narrower and it’s harder to insert a cystoscope. It’s also treatment for adults with larger bladder stones. The procedure requires one incision (cut) in the skin of your lower abdomen and one cut into your bladder.
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Procedure Details

How should I prepare for a cystolitholapaxy?

Your healthcare provider will give you instructions on how to prepare for surgery. These could include instructions about:

  1. What medications to stop taking in the days before surgery. Make sure you tell your surgeon about any medications you take each day. Don’t stop taking a medication unless your provider tells you to.
  2. When you should stop eating and drinking. Most providers ask you to avoid food and drink after midnight the night before surgery.
  3. Arranging for a ride home or for care in your home in the first several hours after surgery.
  4. What you can expect the day of the procedure and afterward.

How is a cystolitholapaxy done?

Cystolitholapaxy is a minimally invasive procedure surgeons use to break up and remove bladder stones.

A cystoscope is a long, thin tube with a camera on the end of it. Your provider inserts a cystoscope into your urethra and into your bladder. The cystoscope shows your surgeon exactly where the stones are in your bladder. Then, they use a tiny laser to break apart the stones into tiny pieces. Finally, your provider washes the stones out of your bladder using fluids.

Before the procedure begins, your healthcare provider will give you anesthesia, so you don’t feel pain. It can either be local or general. Local anesthesia works by blocking pain in a specific area of your body. With general anesthesia, you’re asleep for the procedure.

How long does this procedure take?

The procedure is relatively short, about 30 to 60 minutes. You go home the same day after you recover in a recovery room.

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Are you awake for cystolitholapaxy?

Most people receive general anesthesia. When you have general anesthesia, you’re asleep and won’t feel any pain. Some people receive local anesthesia, which means you’re awake during the procedure but don’t feel pain in your groin area.

Is a cystolitholapaxy painful?

No, it shouldn’t be painful. Your healthcare provider will give you anesthesia, so you don’t feel any pain.

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What should I expect after a cystolitholapaxy?

It’s normal to experience certain symptoms after a cystolitholapaxy. Some things you can expect in the first 72 hours after surgery are:

  • Blood or small blood clots in your pee.
  • Small stones in your pee.
  • Burning sensation when you pee.

Ask your healthcare provider what’s normal after the procedure and when you should worry. It’s a good idea to avoid alcohol, driving or operating heavy machinery or signing any important documents in the first 24 hours after surgery due to leftover anesthesia still being in your system.

Some people may have a catheter in their bladder after surgery to help them pee. This is a tube that takes pee from your bladder and transports it to a bag you wear outside of your body. It may stay in place for up to a week while your body heals, and then, your provider will remove it.

Other self-care instructions may include:

  1. Drink lots of water after surgery.
  2. Take acetaminophen or ibuprofen for mild pain according to the instructions on the label. Contact your healthcare provider if you experience pain that’s unbearable or doesn’t improve.
  3. Take antibiotics if your provider prescribes them to you (to prevent infection).
  4. Take time to rest for the first 24 to 48 hours.

Risks / Benefits

What are the benefits of this procedure?

A cystolitholapaxy is a minimally invasive treatment for bladder stones with a quick recovery time. Left untreated, bladder stones can lead to repeat urinary tract infections (UTIs) and permanent damage to your bladder or kidneys.

What are the complications of cystolitholapaxy?

Cystolitholapaxy is generally a safe and effective procedure. Urinary tract infections (UTIs) are the most common complication of a cystolitholapaxy. About 1 in 10 people develop urinary tract infections (UTIs) after bladder surgery. Antibiotics treat UTIs.

Other rare but possible complications include:

  • Scar tissue formation in your urethra.
  • Excess bleeding.
  • Blood clots in your legs or lungs.
  • Regrowth of bladder stones.
  • Reaction to anesthesia.

Recovery and Outlook

What is the recovery like after a cystolitholapaxy?

Most people make a full recovery within two weeks. You can go back to eating and drinking as usual once you return home. Your provider will suggest you walk around after surgery. This can prevent blood clots in your legs.

Your provider may also make the following recommendations:

  • Avoid strenuous or rigorous exercise for about two weeks.
  • Don’t lift anything heavier than 10 pounds for two weeks.
  • Walking and using the stairs is OK after surgery. Stop if it causes you pain.
  • You can bathe or shower as usual after surgery.
  • Take acetaminophen for pain. Your provider may prescribe prescription pain medication. Use medication only as they direct.
  • Use a stool softener if you have trouble pooping after surgery. Anesthesia can make you constipated.

What kind of follow-up is necessary?

Your healthcare provider will schedule a post-operative appointment with you, usually about one to two weeks after surgery. If you are sent home with a catheter, your healthcare provider will schedule a time for its removal.

Your provider may schedule X-rays or a CT scan to ensure the bladder stones are completely gone and haven’t come back. Bladder stones can come back unless the underlying condition that causes them is treated.

When can I go back to work/school?

Most people can go back to work or school within two to three days, although the exact timing varies depending on how strenuous your job is. You can usually begin exercising, lifting heavy objects and playing sports after 14 days. Talk to your healthcare provider about what you should do based on your situation.

When to Call the Doctor

When should I call my healthcare provider?

Most people don’t have any issues recovering from a cystolitholapaxy. It’s normal to have some side effects of surgery for about one week. But if you experience any of the following after one week, you should call your provider:

  • Severe pain while peeing.
  • Being unable to pee.
  • Red pee or blood clots in your pee (a little blood is normal in the first few days, but your pee shouldn’t look like beet juice).
  • Pain in your back or abdominal area.
  • Fever of higher than 101 degrees Fahrenheit (38.5 degrees Celsius).
  • Chest pain, shortness of breath or breathing difficulties.

Additional Common Questions

What is the difference between a cystoscopy and a cystolitholapaxy?

A cystoscopy is a procedure that looks inside your bladder and urethra. Healthcare providers mainly use it to diagnose bladder problems, such as bladder stones or frequent urinary tract infections. So, it’s possible that you have a cystoscopy as part of your diagnosis and a cystolitholapaxy as part of your treatment.

A note from Cleveland Clinic

Cystolitholapaxy is a safe, minimally invasive treatment for bladder stones. Talk to your healthcare provider before the procedure so you know what to expect from surgery and how to prepare. Recovery typically takes about one week. You should contact your healthcare provider if you have pain while peeing, abdominal or back pain, or blood clots in your pee after a cystolitholapaxy.

Medically Reviewed

Last reviewed by a Cleveland Clinic medical professional on 09/25/2023.

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