Bladder Stone Removal: Pre-Op & Post-Op Care
Pre-operative care: Preparation before the Bladder Stone Removal
Before the start of the cystolithotomy procedure, the patient undergoes a thorough evaluation to ensure fitness for the procedure and to determine the accurate location of the stones.
The urologist evaluates the lower abdomen and may also do it for the rectum to check for an oversized prostate, the most common symptom of bladder stones.
After that, imaging tests like computed tomography, ultrasound, and X-ray are conducted to confirm the size, number, and exact location of the stones.
Urinalysis is done, where a urine sample is evaluated or examined for microscopic amounts of blood, bacteria, and minerals, to rule out any urinary tract infection. If there is any sign of urinary tract infection, they are treated with the use of antibiotics before the start of the cystolithotomy procedure
Blood tests are done for a complete blood count, renal function tests, and a coagulation profile.
The patient needs to inform the specialist doctor of all the medicines they are taking, especially the blood thinners, which the patient needs to stop several days before the start of surgery.
The patient needs to start fasting, that is, not to eat or drink anything, at least six hours before the procedure, to prevent any problems from general anesthesia.
The patients are then advised to take a shower with antibacterial soap the night before the surgery, and in the morning, to reduce the skin bacteria.
On the day of the surgery, the intravenous line is started, and the place of surgery is shaved and disinfected. Written consent is then obtained from the patient, and the risks and benefits are discussed.
Intra-operative care: Cystolithotomy Procedure
This phase involves the cystolithotomy procedure, performed under the influence of anesthesia.
General anesthesia is when the patient is completely asleep during the procedure, and Spinal anesthesia is when the patient is numb from the waist down but usually is awake.
The patient is then placed in a supine position, on their back. The surgeon then performs cystoscopy, a procedure where a small tube with a camera is inserted into the bladder via the urethra. This confirms the location of stones and the number.
A transurethral catheter is then used to fill the bladder with sterile fluid, making it easier to incise. A surgical cut of about 10 cm is then made in the lower abdomen, after which the surgeon gently dissects the area so that the anterior bladder wall is visible. The bladder is then opened, and with the help of a suture, it is held.
Bladder stones are extracted manually, and then the bladder is closed with absorbable sutures, typically in two layers.
A catheter is then inserted into the urethra to drain urine. The abdominal incision is then closed with sutures.
The patient is then awakened from anesthesia and taken to another room for monitoring.
Post-operative care: Cystolithotomy/ Bladder Stone Procedure
After the completion of the cystolithotomy procedure, the patient is managed for pain, is advised to restrict some activities, and then given follow-up care.
After the cystolithotomy procedure, the patient stays in the hospital for two more days to recover.
The surgical team then carefully monitors the patient for any signs of infection, fever, or excessive bleeding.
After the cystolithotomy procedure, the urinary catheter remains in place for 7 to 14 days to allow the bladder to heal. A cystogram is then performed to check for any bladder leakage before the catheter is completely removed.
The recovery procedure at home for the patient involves avoiding all strenuous activities and lifting heavy weights. Light walking is encouraged to prevent blood clots.
The patient is advised to drink plenty of fluids and remain hydrated. Pain medications are given to relieve any slight pain, and antibiotics are prescribed to the patient to avoid infections. Patients are also advised to keep the surgical wounds dry.
Follow-up care involves monitoring the recovery, removing the catheter, and addressing all the underlying causes of bladder stones to prevent recurrence.
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