LITHOLOPAXY

HISTORY
Evidence of bladder stone formation can be traced back to the Egyptian empire of 3000-4000 B.C. over the centuries many h……… but ingenious

methods of removing bladder stones have been devised. In developing centuries, bladder stones, particularly in particularly pre-pubertal boys still occur

frequently. However in the western world, it is elderly patients with bladder outflow obstruction who most commonly develop bladder stones. Men and women

with neuropathic bladder disorders particularly in the presence of an indwelling urethral catheter may also a quire baldder stones.

Principles :
When investigation reveals the presencde of the bladder sones, it is almost always beneficial to the patient that these should be removed. Although

open surgery may be required for the very largest, the majority are available to endoscopic treatment.

Pre operative preparation:
A .prophylactic antibiotic should be given
Lithopaxy trolly
1. Gown pack
2. Leggings
3. OT guaze
4. Abdominal swab
5. Bowel
6. Sponge holder
7. Betadine solution
8. Metal dilators
9. Disposable syringe 10ml
10. Y connection
11. 2%xylocaine jelly
12. Telescope 0degeree and 30 degree
13. Obturator and sheath (cystoscopy sheath 17fr,20fr,22fr)
14. Nephroscope sheath and obturator(25fr)
15. Nephroscope
16. Normal saline for irrigation
17. Graspers
1. Stone crushing forceps
2. Stone punch
3. Opticallithotrite

18. Ellick evacuator
19. Light source

Procedure:
1. The instrument which is used will depend on the size of stone
2. Although blind lithotrites are still available in many hospitals, the risk of crushing drainage with these is greater than with a an instrument which

is used under vision
3. For this reason, either a stone punch , an optical lithotrite or an electohydraulic disintegrator must be used
4. It isd often beneficial to dilate the male urethra so that the sheath of the operating instrument can be accomadated easily
5. An urethrotomy may be provoke bleeding which obscures vision. It6 is also important , if bladder outflow obstruction exista in the form of prostatic

enlargement, that the stone should be removed before trans-urethral prostatectomy again so that vison is not obscured by bleeding from the prostatic fossa.

Whatever instrument is used the urethra should be lubricated liberally with local anaesthetic jelly
Instruments :
1.Stone crushing forceps:
Stones smaller than 0.5cm in diameter can be crushed with forceps which can be passed through a cystoscope sheath
2.Stone punch:
This instrument is passed into the bladder on its obturator stone of upto 1.5cm in diameter can be grasped of crushed under vision
3.Optical lithotrite:
Optical lithotrite is a large heavy instrument which must be passed with care when the bladder is fully open stone of upto 3.5cm in diameter

can be grasped and crushed. When the stone has been crushed who fragments of 2cm or less, the stone punch can be used.
5. Electrohydraulic disintegration:
Large stones must be disintegrated using an electrohydraulic probe. A high tension spark is discharged across the end of the probe between the central core

of circumferential