What is Litholaplaxy?
Litholapaxy is a procedure which engages in the destruction of the calculus of the kidney, ureter, bladder, or gallbladder through physical forces which include crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be utilized even without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis.
Effects of Litholaplaxy
Compared to the visual litholapaxy and cystolithotomy, the litholapaxy is easier to do and more efficient in the length of operating time. There are no complications and there is shorter hospital stay.
The Litholaplaxy Procedure
Lithotrity is a surgical procedure to pulverize stones in the urinary bladder or urethra so that they can be passed out of the body in the urine. It consists of two parts – the crushing of the stone and the removal of the detritus. These two parts may now be carried in one “sitting” without any interval allowed between them and is called litholapaxy. After the patient has been anesthetized, a hot boracic lotion is injected and the lithotrite, which is the crushing instrument, is then passed into the bladder. The lithotrite is composed of two blades, a “male” and a “female”. The “female” blade is fenestrated while the “male” blade is solid with a notched surface. The stone is then fixed between the blades wherein the screw is used applying great pressure evenly and gradually and continuously to the stone. The lithotrite is made of strong steel in order to crush hard stones with no danger of breakage or bending of the instrument.
It is important to take extra care not to catch the bladder wall with the lithotrite. In order to avoid this from happening, the point of the lithotrite is immediately raised following grasping the stone and prior to crushing it. The stone shatters into two or more pieces and the fragments must all be crushed until they are powdered and fine enough to pass through the large evacuating catheter. Large and hard stones require at least a half an hour for it to be crushed sufficiently fine.
The surgeon assumes that the stone has been thoroughly broken up if he cannot catch any more large pieces. When this happens, the lithotrite is then removed and the detritus is washed out by an “aspirator”. This aspirator consists of a firm elastic ball which is attached with a trap wherein the fragments of stone fall so as not to pass out on the instrument utilized during the later periods in the operation. A large catheter is passed into the bladder wherein the eye of the catheter is very near the end of the short curve. The aspirator which is filled with boracic lotion and is connected to the catheter is used to express a few ounces of fluid from it into the bladder by squeezing the rubber ball. When pressure is removed from the ball, it dilates and draws the fluid out of the bladder together with some of the detritus which then falls into the trap. This process is then repeated until all the fragments have been removed.
After undergoing the procedure, the patient must be kept in bed. In cases wherein the stone has been large and the bladder has been irritated, the surgeon would want the patient to remain in the hospital for at least one week; otherwise, the patient may soon be able to perform his or her usual duties.
After undergoing the procedure, there are times where the patient may suffer from discomfort. The patient’s urine must be drawn off through a soft catheter at regular intervals for several days. Fomentations are utilized if the pain is severe.
Fatal terminations happen due to suppression of urine which is a result of the old standing kidney disease which usually complicates these cases.
What is Tactile Litholapaxy?
Tactile litholapaxy is a procedure which is safe and is easy to learn. Stones ranging in size up to 5 cm in diameter may benefit from this procedure except if the stone is very tough. This procedure starts with distending the bladder by irrigating fluid, the lithotrite is then passed, the jaws opened, and the lower jaw is then depressed against the floor of the bladder and vibrated in order to let the stone roll onto it. The upper jaw is then depressed against the stone, the threads at the handle are meshed resulting in the crushing of the stone. The fragments are crushed in the same way, and through a resectoscope sheath, are washed out.