Introduction
Cystolitholapaxy is a minimally invasive surgical procedure used to remove bladder stones. These stones, also known as bladder calculi, can cause significant discomfort and lead to complications if not treated. This procedure involves breaking down the stones into smaller fragments that can be easily extracted through the urethra.
What is Cystolitholapaxy?
Cystolitholapaxy is a medical procedure aimed at treating bladder stones. It is often performed using a cystoscope, a thin tube with a camera and light at the end, which allows the surgeon to view the inside of the bladder. The cystoscope is inserted through the urethra into the bladder, where specialized instruments are used to break up the stones.
Types of Cystolitholapaxy
There are two main types of cystolitholapaxy:
- Transurethral cystolitholapaxy: This is the most common form, where the cystoscope is inserted through the urethra.
- Percutaneous suprapubic cystolitholapaxy: This involves making a small incision in the lower abdomen to access the bladder directly. It is typically used for larger stones or in cases where the urethra is too narrow.
Indications for Cystolitholapaxy
Bladder stones can cause a variety of symptoms and complications, prompting the need for cystolitholapaxy. Common indications include:
- Recurrent urinary tract infections (UTIs): Bladder stones can increase the risk of UTIs, leading to frequent infections.
- Hematuria: The presence of blood in the urine can be caused by bladder stones.
- Bladder pain: Persistent pain or discomfort in the lower abdomen may indicate the presence of stones.
- Urinary retention: Difficulty in emptying the bladder completely can result from bladder stones obstructing the urinary tract.
- Frequent urination: The constant urge to urinate, even when the bladder is not full, can be a symptom of bladder stones.
The Cystolitholapaxy Procedure
The procedure generally involves several steps:
- Preparation: The patient is typically given anesthesia to ensure comfort during the procedure. This can be general anesthesia, where the patient is asleep, or regional anesthesia, where the lower part of the body is numbed.
- Insertion of the cystoscope: The cystoscope is carefully inserted through the urethra into the bladder, allowing the surgeon to visualize the stones.
- Fragmentation of stones: Specialized instruments, such as lasers or ultrasonic devices, are used to break the stones into smaller pieces.
- Removal of fragments: The fragments are then flushed out of the bladder or removed using grasping instruments.
- Final inspection: The surgeon ensures that all stone fragments have been removed and that the bladder is clear.
Recovery and Aftercare
Post-procedure care is crucial for a smooth recovery. Patients may experience some discomfort, which can be managed with pain medication. It is essential to follow the doctor’s instructions regarding fluid intake, activity restrictions, and follow-up appointments. Patients are also advised to:
- Drink plenty of water to flush out any remaining stone fragments.
- Avoid strenuous activities for a specified period.
- Monitor for signs of infection, such as fever or unusual pain, and report them to the doctor.
Benefits of Cystolitholapaxy
Cystolitholapaxy offers several advantages, including:
- Minimally invasive: The procedure avoids large incisions, reducing recovery time and the risk of complications.
- Effective stone removal: It effectively breaks down and removes bladder stones, relieving symptoms and preventing complications.
- Quick recovery: Most patients can resume normal activities within a few days to a week after the procedure.
Risks and Complications
As with any medical procedure, cystolitholapaxy carries some risks. Potential complications include:
- Infection: There is a risk of urinary tract infection (UTI) following the procedure.
- Bleeding: Some bleeding may occur during or after the procedure.
- Injury to the bladder or urethra: Rarely, the instruments used during the procedure can cause injury.
- Incomplete stone removal: In some cases, not all stone fragments are removed, requiring further treatment.
Nursing Care of Patients Undergoing Cystolitholapaxy
Nursing care for patients undergoing cystolitholapaxy involves a multidisciplinary approach to ensure patient safety, comfort, and a smooth recovery process. This document outlines the key aspects of preoperative, intraoperative, and postoperative nursing care.
A. Preoperative Care
Patient Education
Nurses should educate patients about the cystolitholapaxy procedure, including its purpose, benefits, potential risks, and expected outcomes. This helps to alleviate anxiety and ensure informed consent.
Medical History and Assessment
A thorough medical history should be taken to identify any underlying conditions that may affect the procedure or recovery. Assess the patient’s medications, allergies, and previous surgical history.
Preparation
- Ensure that the patient has completed necessary preoperative tests, such as blood work and urinalysis.
- Instruct the patient to follow preoperative fasting guidelines.
- Provide preoperative medications as ordered by the physician.
B. Intraoperative Care
Monitoring
During the procedure, close monitoring of the patient’s vital signs is crucial. This includes heart rate, blood pressure, oxygen saturation, and respiratory rate.
Assistance
Nurses should assist the surgical team as needed, ensuring that all instruments and equipment are readily available and functioning correctly.
Patient Comfort
- Ensure the patient is positioned comfortably and securely on the operating table.
- Monitor the patient for signs of discomfort or distress and report any abnormalities to the surgical team immediately.
C. Postoperative Care
Recovery Room Monitoring
After the procedure, the patient should be closely monitored in the recovery room. Vital signs should be checked regularly, and the patient should be observed for any signs of complications such as bleeding or infection.
Pain Management
Effective pain management is essential for patient comfort and recovery. Administer prescribed pain medications and assess the patient’s pain levels regularly. Offer non-pharmacological pain relief methods as well, such as ice packs or relaxation techniques.
Infection Prevention
- Monitor for signs of urinary tract infection (UTI) such as fever, chills, and dysuria.
- Encourage proper hygiene and provide instructions on how to keep the catheter site clean if a catheter is in place.
- Administer prophylactic antibiotics as prescribed.
Hydration and Nutrition
- Encourage the patient to drink plenty of fluids to flush out any remaining stone fragments and reduce the risk of UTI.
- Ensure the patient resumes a normal diet as tolerated, with a focus on balanced nutrition to support healing.
Patient Education
Before discharge, educate the patient on postoperative care at home. This includes:
- Instructions on fluid intake
- Signs of complications to watch for, such as fever, severe pain, or blood in urine
- Activity restrictions and gradual return to normal activities
- Follow-up appointments with the healthcare provider
Emotional Support
Provide emotional support to the patient and their family. Recovering from surgery can be stressful, and offering reassurance and answering any questions can help ease their concerns.
Case Management
Coordinate with the multidisciplinary team to ensure all aspects of patient care are addressed. This includes liaising with physicians, physical therapists, and dietitians to provide holistic care.
REFERENCES
- Leslie SW, Sajjad H, Murphy PB. Bladder Stones. https://www.ncbi.nlm.nih.gov/books/NBK441944/. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan
- Goldsmith L, Neal N, Briggs J, et al. Percutaneous cystolitholapaxy: A safe and effective alternative to open stone surgery for the management of complex bladder stones in patients with no urethral access. Journal of Clinical Urology. 2019;13(2):106-109. doi:10.1177/2051415819830191
- Li A, Ji C, Wang H, et al. Transurethral cystolitholapaxy with the AH-1 stone removal system for the treatment of bladder stones of variable size (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4343269/). BMC Urol. 2015;15(1):9. Published 2/21/2015.
- Okeke Z, Shabsigh A, Gupta M. Use of Amplatz sheath in male urethra during cystolitholapaxy of large bladder calculi. Urology 2004;64(5):1026-7.
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