What does this procedure involve?
Litholapaxy involves crushing or disintegrating bladder stone(s) using telescopic fragmentation devices or a laser passed through your urethra (waterpipe). Once the stone has been broken up, the small fragments produced can be removed using suction.
What are the alternatives?
- Observation – “doing nothing”
- Open surgery – cutting into the abdomen and opening the bladder directly to remove the stone
- Laparoscopic or percutaneous surgery – using keyhole surgery to put a telescope directly into the bladder, through the skin of your abdomen (tummy), and remove your stone
What happens on the day of the procedure?
Your urologist (or a member of their team) will briefly review your history and medications, and will discuss the surgery again with you to confirm your consent.
An anaesthetist will see you to discuss the options of a general anaesthetic or spinal anaesthetic. The anaesthetist will also discuss pain relief after the procedure with you.
We may provide you with a pair of TED stockings to wear, and we may give you a heparin injection to thin your blood. These help to prevent blood clots from developing and passing into your lungs. Your medical team will decide whether you need to continue these after you go home.
Details of the procedure
- We use either a general anaesthetic (where you will be asleep) or a spinal anaesthetic (where you will be unable to feel anything from the waist down)
- We usually give you an injection of antibiotics before the procedure, after you have been checked for any allergies
- We put a telescope into your bladder through the urethra (water pipe) to inspect the urethra and the interior of your bladder
- We wash out small stones through the telescope
- We break up larger stones using a crushing instrument, laser energy or a mechanical disintegration device
- The stone fragments are then removed using simple suction
- We usually put in a bladder catheter which is removed after one to three nights
- The procedure takes 15 to 60 minutes to perform
- You can expect to be in hospital for two to three days
Further information and a video of telescopic crushing of a bladder stone are available on the BAUS website.
Are there any after-effects?
The possible after-effects and your risk of getting them are shown below. Some are self-limiting or reversible, but others are not. We have not listed very rare after-effects (occurring in less than 1 in 250 patients) individually. The impact of these after-effects can vary a lot from patient to patient; you should ask your surgeon’s advice about the risks and their impact on you as an individual:
| After-effect | Risk |
|---|---|
| Mild burning on passing urine for a short time after the procedure |
 Almost all patients |
| Infection of the bladder requiring antibiotic treatment |
 Between 1 in 2 & 1 in 10 patients |
| Bleeding for a few days after the procedure |
 Between 1 in 10 & 1 in 50 patients |
| Failure to remove all the stones (or stone fragments) |
Between 1 in 10 & 1 in 50 patients |
| Anaesthetic or cardiovascular problems possibly requiring intensive care (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death) |
 Between 1 in 50 & 1 in 250 patients (your anaesthetist can estimate your individual risk) |
| Injury to the urethra resulting in scarring which may require further surgery |
Between 1 in 100 & 1 in 250 patients |
| Perforation of the bladder requiring open surgical exploration and repair |
Between 1 in 100 & 1 in 250 patients |
What is my risk of a hospital-acquired infection?
Your risk of getting an infection in hospital is between 4 & 6%; this includes getting MRSA or a Clostridium difficile bowel infection. This figure is higher if you are in a “high-risk” group of patients such as patients who have had:
- Long-term drainage tubes (e.g. catheters)
- Long hospital stays
- Multiple hospital admissions
What can I expect when I get home?
- You will be given advice about your recovery at home
- You will be given a copy of your discharge summary and a copy will also be sent to your GP
- Any antibiotics or other tablets you may need will be arranged & dispensed from the hospital pharmacy
- You should drink twice as much fluid as you would normally for the first 24 to 48 hours, to flush your system through and reduce the risk of infection
- Passing urine may be painful at first and the urine you pass may be slightly bloodstained; this should settle within a few days
- You may return to work when you are comfortable enough and when your GP is satisfied with your progress
- If you develop a fever, frequent passage of urine, severe pain on passing urine, inability to pass urine or worsening bleeding, you should contact your GP immediately
- A follow-up outpatient appointment will normally be made to see you at an appropriate time
General information about surgical procedures
Before your procedure
Please tell a member of the medical team if you have:
- An implanted foreign body (stent, joint replacement, pacemaker, heart valve, blood vessel graft)
- A regular prescription for a blood thinning agent (e.g. warfarin, aspirin, clopidogrel, rivaroxaban, dabigatran)
- A present or previous MRSA infection
- A high risk of variant-CJD (e.g. if you have had a corneal transplant, a neurosurgical dural transplant or human growth hormone treatment)
Questions you may wish to ask
If you wish to learn more about what will happen, you can find a list of suggested questions called “Having An Operation” on the website of the Royal College of Surgeons of England. You may also wish to ask your surgeon for his/her personal results and experience with this procedure.
Before you go home
We will tell you how the procedure went and you should:
- Make sure you understand what has been done
- Ask the surgeon if everything went as planned
- Let the staff know if you have any discomfort
- Ask what you can (and cannot) do at home
- Make sure you know what happens next
- Ask when you can return to normal activities
We will give you advice about what to look out for when you get home. Your surgeon or nurse will also give you details of who to contact, and how to contact them, in the event of problems.
Smoking and surgery
Ideally, we would prefer you to stop smoking before any procedure. Smoking can worsen some urological conditions and makes complications more likely after surgery. For advice on stopping, you can:
- Contact your GP
- Access your local NHS Smoking Help Online
- Ring the free NHS Smoking Helpline on 0300 123 1044
Driving after surgery
It is your responsibility to make sure you are fit to drive after any surgical procedure. You only need to contact the DVLA if your ability to drive is likely to be affected for more than three months. If it is, you should check with your insurance company before driving again.