Cystolithotripsy

Cystolithotripsy is a medical procedure to fragment bladder stones (cystoliths) to facilitate removal and relieve symptoms such as urinary irritation, obstruction, or recurrent infections. It is typically performed under anesthesia. The procedure can be performed transurethrally using a cystoscope and a lithotripter, employing ultrasonic, pneumatic, or laser energy to fragment stones. Fragments are retrieved with forceps or baskets or allowed to pass.

Alternatively, percutaneous cystolithotomy is used for large stones; a tract is created through the bladder wall, and fragments are removed, sometimes after endoscopic fragmentation. Extracorporeal shock wave lithotripsy may be used in selected cases, though it is less common for bladder stones.

Indications include symptomatic bladder stones, large stones that cannot be evacuated by endoscopy alone, stones associated with urinary diversion or neurogenic bladder, and stones in patients with chronic catheterization or infection.

Outcomes are generally favorable, with many patients achieving stone-free status after one or more sessions. Complications are uncommon but can include urethral or bladder mucosal injury, bleeding, urinary tract infection, urinary retention, bladder perforation, and recurrence of stones.

Comparison with alternatives: open vesicolithotomy is reserved for very large stones, multiple procedures, or complex anatomy; ESWL or endoscopic approaches are chosen based on stone size, location, patient factors, and available equipment.

History: cystolithotripsy has evolved from open surgery to minimally invasive endoscopic techniques, improving safety and recovery.