Urology

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Cystoscopy with a rigid cystoscope, crushing stones in the urinary bladder

What does this procedure entail?

The purpose of this medical procedure is to break up / crush the stone(s) in the bladder using telescopic tools and eventually electrohydraulic, pneumatic or ultrasonic crushing instruments. Stone fragments are then mechanically removed from the bladder or aspirated. The surgery is performed under general anaesthesia during hospitalisation.

What are the alternatives to this procedure?

standard surgery
observation (monitoring)

What should I expect before this procedure?

If you regularly use Anopyrin, Clopidogrel, Warfarin, etc., you must tell your doctor. These medications can be associated with increased risk of bleeding during and after the surgery if they are not stopped in time. In some cases, it is necessary to replace these drugs with injection preparations. It is necessary to consult your general practitioner or cardiologist about this approach.

At the request of the referring physician, you will have to schedule preoperative examinations (if general anaesthesia is planed) to assess your overall condition, including laboratory and instrumental tests. If the report does not preclude the indicated procedure, you will be admitted to the hospital. If you don’t undergo a preoperative examination or it is incomplete, you will not be able to have the surgery as scheduled. You will be admitted by a nurse and a member of the medical team will complete your examination and assess your fitness for the surgery.

You will be asked not to eat or drink for at least 6 hours before the surgery!

Remember to inform your physician about the following possible facts before the surgery:

- artificial heart valve
- coronary artery stent
- pacemaker
- artificial joint
- artificial vascular graft
- neurosurgical bypass
- other implanted foreign body
- use of the following prescription drugs: Acylpyrin, Anopyrin, Aspirin, Godasal, Clopidogrel, Plavix, Kardegic, Aspegic, Micristin, Ibustrin,Ticlid, Tagren, Ipaton  Apo-Tic, Plavix, Persantin, Curantyl, Anturan, Aggrenox, Vessel due F.
- drug and other allergies – any abnormalities or eventualities

It is NECESSARY to inform the physician about your use of drugs affecting blood clotting before your admission for the procedure.

What will happen during the surgery?

You will normally receive an injection or oral antibiotics before the procedure, but any allergies must be checked first.
A telescopic instrument is inserted through the urethra – sometimes it is necessary to widen the outer orifice of the urethra to insert the instrument. Under visual control, the stone is divided into smaller fragments, which are crushed mechanically or using electrohydraulic, pneumatic or ultrasonic crushing instruments. A urinary catheter is inserted after the procedure. The procedure itself takes 30-60 minutes, depending on the size, number and hardness of the stones.

What will happen immediately after the procedure?

If the procedure was performed under general anaesthesia, you will wake up at the post-operative unit equipped for constant monitoring of patients immediately after the procedure. The surgeon will inform you about the course of the procedure. You will still have high levels of anaesthetics in your blood at that time, so you may not remember this conversation.

Once you are fully conscious, you should:

ask if the planned outcome was achieved
inform the medical staff about any problems
ask what you can and cannot do
ask all the questions you have for the healthcare professionals and members of the medical team. remember (and understand) why the surgery was performed, how it turned out, and what will follow

The catheter is removed from the bladder within 1-2 days and you should be able to urinate normally. Burning when urinating, higher frequency of urination and blood in the urine are common for 24-48 hours after the catheter removal. The usual hospitalisation is 5 days.

An X-ray is sometimes performed after the surgery to check that all fragments have been completely removed.

What are the postoperative risks or complications?

Common (10% of procedures of this type)

Slight burning or bleeding when urinating for a short time after the procedure
Temporary need for a short-term catheter inserted into your bladder
The need for further surgery (e.g. prostate surgery) if it is obvious that it is the cause of stone formation

Occasional (2-10% of procedures of this type)

Inflammation of the bladder requiring antibiotic treatment
Need for bladder wall sampling in case of relevant findings
Repeated formation of stones or residual fragments

Rare (may occur in 2% of procedures of this type)

Subsequent bleeding requiring clot removal or surgical revision
Injury to the urethra, which causes a scarring and narrowing
Very rare bladder injury requiring temporary insertion of a urinary catheter or surgical revision.

Hospital infections

MRSA colonisation (0.9% – 1 of 110)
Intestinal infection by clostridium difficile (0.01% – 1 of 10,000)
MRSA blood infection (0.02% – 1 of 5,000)

Hospital infection rates may be higher in high-risk patients, such as in cases requiring long-term drainage, after a previous infection, after prolonged hospitalisation or after multiple hospitalisations.

What should I expect when I return home?

When you are discharged from the hospital, you should:

Get recommendations on recovery at home
Ask when you can return to normal activities such as work, exercise, driving, housework
Get a contact number for further questions after returning home or in case of trouble
Ask about the date and place of subsequent check-ups (hospital or your doctor)
Make sure you are aware of the reason, course and outcome of the surgery, the results of examinations or the removal of tissues or organs.

At your departure from hospital (sometimes several days later), you will receive a hospitalisation report / report on the performed procedure. The document contains important information about your hospital stay, your surgery and recommended follow-up. If you need to call your attending physician or visit the hospital for any reason, take this document with you so that the physician knows the details of your treatment. This is especially important if you need to consult another doctor or longer after discharge.

After returning home, you should drink 2x more fluids than normal for the next 24-48 hours. When urinating, you may initially experience burning and tingling up to pain, and blood may be present in the urine. These problems will quickly disappear if you have a high fluid intake.