Operative removal of stones from the bladder in men who suffer from urolithiasis due to the anatomical features of the urethra is much more likely than women to be the most reliable way to get rid of these formations.
The most common method of removal in people of both sexes today is transurethral cystolitholapaxy (endoscopic removal of the stone from the bladder through the natural openings of the body). Through the urethra, a thin fiber-optic (flexible) or metal (rigid) cystoscope is inserted into the bladder, equipped with a video camera that allows visualizing the object and controlling the operation. The cystoscope is brought directly to the calculus, through which an energy impulse is transmitted. For crushing at the present time, ultrasound and laser energy is often used, which makes it possible to break the stones to the state of sand, which is washed from the bladder by a sterile liquid. Ultrasound is recommended for use in low-density concrements. Laser technology is considered the most effective and accurate. The use of a laser beam does not damage nearby tissues, but acts exactly on the object of crushing.
The method of electrohydraulic cystolithotripsy, in which a fixed stone is crushed from one side (the least strong), is more effective when placing stones in the ureter and kidneys. But it is also used to remove solid formations from the bladder.
A mechanical lithotriptor is also used, with which the calculi are fragmented step by step. The specialist grasps the stone, moving it to the center of the bladder, and there he crushes, periodically washing the bladder to ensure good visual control. The procedure continues until the formation is completely destroyed. Minuses of the pneumatic method are the probability of injuries of soft tissues or casting stones in the kidney.
After any endoscopic procedure, small fragments are removed by means of special devices or sucked off by vacuum from the urethra. Since the operation is performed under absolute visual control, urethral lesions are practically absent. Contact lithotripsy is performed in the hospital of the urological department under general or spinal anesthesia, where the patient usually spends two to three days. Sometimes after the procedure, there is a need for a catheter in the bladder.
Remote lithotripsy is carried out by means of a narrowly directed short-time high-pressure pulse (shock acoustic wave). This method is shown in the case of secondary deposits, in the absence of obstructions to the outflow of urine and the location in the neck of the urethra. Stones that have arisen against the background of prostatic hyperplasia are not removed by this method.
This method of removal is the most sparing of all, does not require preliminary analgesia or, in the case of a low pain threshold of the patient, it is enough to inject an analgesic. When it is used, the integrity of the tissues is not impaired. The procedure for directing the shock wave is controlled by ultrasonic or roentgenological equipment. Extracorporeal shock wave therapy can be performed on an outpatient basis. However, its main drawback is not always the complete excretion of fragments from the bladder. The probability of success of this procedure is just over 50%. With incomplete excretion of fragments of concrements, the patient experiences complications in the form of periodic attacks of pain. In this way, the removal of stones from the bladder is well carried out in women, since a short and wide urethra allows easy removal of shattered stone fragments outwards. In men, the fragments can be removed in 1-1.5 hours after the procedure of crushing with a laparoscope (through micro cuts) or percutaneous puncture (puncture).
Percutaneous suprapubic cystolitholapaxia is the operation of choice in childhood, since it allows not to injure the urethra. In adults, this operation is carried out for the removal without crushing large enough stones (with contraindications to crushing) or in combination with remote lithotripsy to remove large fragments that do not exit through the urethra. The stones are removed through a microcut in the lower abdomen and the bladder membrane. The operation is performed under general anesthesia in the hospital, and some time is required for recovery after the intervention.
An open surgical procedure to remove stones is performed if it is impossible to get to them through the urethra (inflammation, constriction, adenoma of the prostate gland). From the previous operation, the procedure is characterized by a large volume and, correspondingly, traumatism. The surgeon makes a cut in the lower abdomen and in the bladder membrane, his internal examination and removal of solid formations becomes available, after which he is sutured, and seams are placed on the wound.
In order to prevent bladder dysplasia and development of neoplasms in the presence of visually perceptible transformations of the internal membrane of the organ after removal of the stone, a tissue biopsy is taken for subsequent histological examination.
Performed under general anesthesia, after the operation for a few days, a catheter is installed. During the operation, remove stones larger than 4 cm or ingrown into the shell of the bladder. This type of surgical treatment is chosen when it is necessary to simultaneously remove other pathologies - adenoma of the prostate gland, diverticulum of the bladder.
The main disadvantages of cavitary surgery are traumatic and long-term rehabilitation.