A Cystolitholapaxy involves going through the urine channel (urethra) with a scope to break up

and remove bladder stones.

After Surgery

You may have blood in your urine. It should clear in 2-3 days. If you had a bladder biopsy, you
may pass tiny blood clots for 2-3 days. Drink more fluids to help clear the clots.

You may also feel burning when you pass urine for 1-2 days.

You may have pain. You may take Tylenol® for relief. Your doctor will order stronger pain
pills for you, if needed.

Activity

• Do not drive for 24 hours. Do not drive if you are taking narcotic pain pills.
• Wait 2 weeks before having sex.
• Do not lift more than 15 pounds for 2 weeks.
• Nothing strenuous for 24 hours. If you notice an increase in bleeding, rest and drink
more fluids. If your urine does not clear call your doctor.

Diet

1. Return to your normal diet as you feel ready to eat.

2. For the next 2 weeks, drink at least 10-12 (8 oz) glasses of fluid each day. No alcoholic
drinks for the first week.
Follow-Up Care

Your first follow-up visit will be made for you.

When to Call the Doctor

• Bloody urine after 2-3 days.

• Large blood clots in urine.
• Unable to pass urine.
• Cloudy or foul-smelling urine.
• New lower back or hip pain.
• Burning when you pass urine (that does not go away after 1-2 days).
• Temperature greater than 100.5° F by mouth, for 2 readings taken 4 hours apart.

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Cystolitholapaxy
Pronounced: sis-TOE-litho-lay-pak-see

by Deanna M. Neff, MPH

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call

Your Doctor

En Español (Spanish Version)

Definition
This is a procedure to break up bladder stones into smaller pieces and remove them. Bladder
stones are minerals that have built up in the bladder. Ultrasonic waves or lasers may be delivered
through a tool called a cystoscope to break up the stones.

Bladder Stone

© 2009 Nucleus Medical Media, Inc.

Reasons for Procedure

This procedure is done to treat bladder stones.

Possible Complications
Complications are rare, but no procedure is completely free of risk. If you are planning to have a
cystolitholapaxy, your doctor will review a list of possible complications, which may include:

• Urinary tract infection

• Bladder tear or damage
• Bleeding
• Reaction to the anesthesia
• Infection
• Damage to internal tissue or structures

Be sure to discuss these risks with your doctor before the procedure.
What to Expect
Prior to Procedure

Your doctor may do the following:

• Physical exam, blood and urine tests, and imaging tests

• Discuss with you the type of anesthesia that will be used and the potential
risks

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up
to one week before the procedure, like:

• Aspirin or other anti-inflammatory drugs

• Blood thinners, like warfarin (Coumadin)
• Clopidogrel (Plavix)

Other things to keep in mind before the procedure:

• Arrange for a ride home from the hospital.

• If instructed by your doctor, do not eat or drink for eight hours before the
procedure.

Anesthesia

This procedure can be done under local, spinal, or general anesthesia. It will block any pain.
Sedation may also be used to ease anxiety.

With local anesthesia, a special jelly or fluid will be inserted into your urethra (the tube that
carries urine out of the body). This will numb the area. If you are having spinal anesthesia, it will
be injected into your spine. General anesthesia will be given through an IV (needle in your arm).

Description of Procedure

The doctor will place a tiny flexible probe, called a cystoscope, through your urethra toward the
bladder. The probe has a camera for viewing. Imaging guidance, like ultrasound, will help the
doctor locate the bladder stones. A saline solution may be flushed through the urinary tract. Once
a stone is located, the doctor will grab the stone and turn on the device to break it. To do this,
different types of technology (eg, ultrasonic waves, lasers, or a mechanical device) can be used.
A special basket or forceps will be used to grab the stone fragments and remove them.

The bladder and surrounding structures will be examined. The doctor may place a stent in your
urethra to help protect the lining while the fragments pass or to repair damage.

Immediately After Procedure

Depending on the type of anesthesia used, you may be able to move around after the procedure.
You may still have a catheter inside your urethra.

How Long Will It Take?

This is usually done in an outpatient setting. You will not need to stay overnight. The procedure
takes 30-60 minutes (or longer) depending on the size of the stones.

How Much Will It Hurt?

Anesthesia prevents pain during the procedure. Ask your doctor about medicine to help with the
pain after the procedure.

Post-procedure Care

At the Care Center

After the procedure, the hospital staff may provide the following care:

• Monitor you while you recover from the anesthesia and/or sedation
• Remove any IV needles and the catheter
• Help you to eat and move around again
• Give you pain medicine

At Home

When you return home, do the following to help ensure a smooth recovery:

• Take medicines as directed to reduce pain and the chance of infection.

• Avoid hard activity and heavy lifting.
• Drink plenty of fluids (eg, 8-10 glasses per day).
• Do not drive or have sex until your doctor says it is safe to do so.
• Be sure to follow your doctor’s instructions.

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

• Increasing pressure or pain while passing urine

• Pain in the back or abdomen
• Not able to urinate
• Changes in frequency, odor, appearance, or volume of urine
• Signs of infection, including fever or chills
• Blood in urine or blood clots after the first few days
 • Painful urination or a burning sensation after the first few days
• Leaking urine

In case of an emergency, CALL 911.

RESOURCES:

American Urological Association

http://www.auanet.org/

National Institute of Diabetes and Digestive and Kidney Diseases

http://www2.niddk.nih.gov/

CANADIAN RESOURCES:

Canadian Urological Association

http://www.cua.org/

Health Canada
http://www.hc-sc.gc.ca/index-eng.php

REFERENCES:

Ho KL, Segura J. Lower Urinary Tract Calculi: Cystolitholapaxy. In: Wein AJ, ed. Campbell-
Walsh Urology. 9th ed. Philadelphia, PA: Saunders Elsevier; 2007:chap 84.

Mayo Clinic. Bladder stones: treatment and drugs. Mayo Clinic website. Available at:
http://www.mayocli.... Updated January 16, 2010. Accessed August 12, 2010.

Neff D. Electrohydraulic lithotripsy. EBSCO Health Library website. Available at:

http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81. Updated August 12, 2010.
Accessed August 12, 2010.

University of Wisconsin Health. Cystoscopy with bladder biopsy, cystolitholapaxy. University of

Wisconsin Health website. Available at: http://www.uwhealt..., 2009. Accessed August 12, 2010.

Last reviewed September 2010 by Adrienne Carmack, MD

Last Updated: 9/15/2010

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