Litholapaxy
Summary: Crushing of a bladder stone & evacuation of the fragments
Contents:
- What does the procedure involve?
- What are the alternatives to this procedure?
- What should I expect before the procedure?
- What happens during the procedure?
- What happens immediately after the procedure?
- What should I expect when I get home?
- What else should I look out for?
- Are there any other important points?
- Is there any research being carried out in this field?
- Who can I contact for more help or information?
- Can I obtain a printed version of this information?
- Side effects & risks
What does the procedure involve?
This procedure involves crushing or disintegration of bladder stone(s) using telescopic instruments or laser and removal of the stone fragments using suction apparatus.
What are the alternatives to this procedure?
Open surgery, observation.
What should I expect before the procedure?
You will usually be admitted on the same day as your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse.
You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.
Please be sure to inform your Urologist in advance of your surgery if you have any of the following:
- an artificial heart valve
- a coronary artery stent
- a heart pacemaker or defibrillator
- an artificial joint
- an artificial blood vessel graft
- a neurosurgical shunt
- any other implanted foreign body
- a prescription for Warfarin, Aspirin or Clopidogrel (Plavix®)
- a previous or current MRSA infection
- high risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or previous injections of human-derived growth hormone)
What happens during the procedure?
Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you.
You will usually be given injectable antibiotics before the procedure, after checking for any allergies.
A special telescope is inserted into the bladder to see the stones. These are then broken up using a crushing instrument (see above), a mechanical disintegration probe or a laser. The stone fragments are removed from the bladder, using a special suction evacuator (see below) and a catheter inserted.
What happens immediately after the procedure?
The catheter will be removed within 24-48 hours following which you will be able to pass urine normally. Some burning, frequency of urination and bleeding are common within the first 24-48 hours after catheter removal.
It is not unusual for a plain X-ray of your abdomen to be performed on the day after surgery to confirm that all the stone fragments have been removed.
The average hospital stay is 5 days.
What should I expect when I get home?
When you get home, you should drink twice as much fluid as you would normally for the next 24-48 hours to flush your system through. You may find that, when you first pass urine, it stings or burns slightly and it may be lightly bloodstained.
When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.
What else should I look out for?
If you develop a fever, severe pain on passing urine, inability to pass urine or worsening bleeding, you should contact your GP immediately.
Are there any other important points?
A follow-up appointment will be arranged before your discharge from hospital. If you have any concerns about the timing of further treatment, please discuss this with your named nurse or Consultant.
Driving
It is your responsibility to ensure that you are fit to drive following your surgery. You do not normally need to notify the DVLA unless you have a medical condition that will last for longer than 3 months after your surgery and may affect your ability to drive. You should, however, check with your insurance company before returning to driving. Your doctors will be happy to provide you with advice on request.
Is there any research being carried out in this field?
There is no specific research in this area at the moment but all operative procedures performed in the department are subject to rigorous audit at a monthly Audit & Clinical Governance meeting.
Who can I contact for more help or information?
Oncology Nurses
- Bladder cancer Nurse Practitioner (cystectomy patients) -
01223 586748 - Bladder cancer Nurse Practitioner (haematuria, chemotherapy & BCG) - 01223 274608
- Prostate cancer Nurse Practitioner - 01223 216574
- Uro-Oncology Clinical Nurse Specialist (kidney patients) - 01223 257167
Non-Oncology Nurses
- Urology Nurse Practitioner (incontinence, urodynamics, catheter patients) - 01223 274608 or 568748
Patient Advice & Liaison Centre (PALS)
- Telephone +44 (0)1223 216756 or 257257
- PatientLine *801 (from patient bedside telephones only)
- E mail PALS
- PALS, Box No 53, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ
Chaplaincy and Multi-Faith Community
- Telephone +44 (0)1223 217769
- E mail the chaplain
- The Chaplaincy, Box No 105, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ
MINICOM System ("type" system for the hard of hearing)
- Telephone +44 (0)1223 274604
Access Office (travel, parking & security information)
- Telephone +44 (0)1223 586969
Can I obtain a printed version of this information?
Yes. You can print this Infosheet by using the print option on your browser or by clicking the "Print Infosheet" button at the top of this page.
If you wish to obtain the formal, printed version from Addenbrooke's or Hinchingbrooke, please contact your Consultant or Specialist Nurse.
To obtain this information in other languages, large print or audio format, e-mail Patient Information at Addenbrooke’s or telephone +44(0)1223 216032.
common Side-effects (greater than 1 in 10)
- Mild burning or bleeding on passing urine for short period after operation
- Temporary insertion of a catheter
- Need for an additional procedure (e.g. resection of the prostate gland) if this is thought to be the cause of the stone formation
occasional Side-effects (between 1 in 10 and 1 in 50)
- Infection of bladder requiring antibiotics
- Permission for telescopic removal/ biopsy of bladder abnormality/stone if found
- Recurrence of stones or residual stone fragments
rare Side-effects (less than 1 in 50)
- Delayed bleeding requiring removal of clots or further surgery
- Injury to the urethra causing delayed scar formation
- Very rarely, perforation of the bladder requiring a temporary urinary catheter or return to theatre for open surgical repair
Hospital-acquired infection (overall risk for Addenbrooke’s Urology)
- Colonisation with MRSA - 0.14% (1 in 700)
- Clostridium difficile bowel infection - 0.04% (1 in 2500)
- MRSA bloodstream infection - 0.08% (1 in 1250)
(These rates may be greater in high-risk patients e.g. with long-term drainage tubes, after removal of the bladder for cancer, after previous infections, after prolonged hospitalisation or after multiple admissions)
