Laser versus contact lithotripter
The holmium laser is effective even with very dense stones (urates, oxalates), on which the pneumatic “slips” and does not create impact recoil, so the stone does not “run away” through the bubble. The laser fiber is thin, which allows you to work through a narrow cystoscope with minimal trauma to the urethra. The disadvantage is time: with a large stone, “dusting” takes longer than mechanical splitting, so for stones larger than 4 cm, the contact or percutaneous option is more profitable. At the same time, laser enucleation of the adenoma (HoLEP) can be performed if it is the cause of the stone.
Indications
- bladder stone of any size, confirmed by ultrasound, x-ray or cystoscopy;
- pain in the lower abdomen, intermittent stream, blood in the urine, frequent urges, recurrent cystitis;
- stones due to prostate adenoma - the operation is combined with TUR or HoLEP;
- stones in patients with cystostomy or neurogenic bladder;
- stones on foreign bodies or after bladder surgery.
How is cystolithotripsy performed?
Under spinal or general anesthesia, a cystoscope is inserted through the urethra. Under the control of a video camera, the surgeon brings a holmium laser to the stone, which destroys stones of any density into small fragments, or a pneumatic (ultrasonic) lithotripter - it copes with large stones faster. All fragments are thoroughly washed and removed, the cavity of the bladder is inspected to ensure that no fragments remain. At the end, a catheter is installed for 1–2 days.
If the stone is larger than 4-5 cm, very dense or the urethra is narrowed, percutaneous access is used - a puncture above the pubis, through which a nephroscope and a powerful lithotripter are inserted. Open surgery (epicystolithostomy) is rarely performed today - in case of giant stones or the impossibility of endoscopy. It is important to simultaneously eliminate the cause: in case of adenoma, a TURP or HoLEP of the prostate is performed during the same operation, otherwise stones will form again.
Preparation
Examination: Ultrasound of the bladder with assessment of residual urine and prostate, plain image or MSCT to determine the size and density of the stone, uroflowmetry, cystoscopy if indicated. Tests: general and biochemical blood test, coagulogram, general analysis and urine culture - the infection must be cured before surgery. ECG and consultation with an anesthesiologist. Anticoagulants are discontinued 5–7 days in advance by agreement. Hospitalization on the day of surgery, 8 hours on an empty stomach.
Recovery and prevention
After endoscopic surgery, the patient spends 1 day in the hospital, the catheter is removed on the 1st–2nd day. In the first days, a burning sensation and blood in the urine are possible. It is recommended to drink plenty of fluids, take an antibiotic as prescribed, and limit exercise for 1–2 weeks. The main condition for the absence of relapse is to eliminate the cause of urinary stagnation: treatment of adenoma, stricture, neurogenic disorders. Control ultrasound after 1 month; analysis of the composition of the stone helps to choose a diet.
Removal of bladder stones in Tashkent
In the clinics below, cystolithotripsy is performed with a laser and a contact lithotripter transurethrally and percutaneously, including simultaneously with TUR or HoLEP of the adenoma. The price list shows options for single and multiple stones; anesthesia and bed days are paid according to the price list. Make an appointment with the ultrasound result.
