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Litholaplaxy
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.
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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.
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Candidates for Litholaplaxy
Patients who have stones in their bladder are
the best candidates for this procedure.
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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.
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Recovery
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.
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Risks
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.
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Frequently Asked Questions
Q:
What is Litholapaxy?
A:
Litholapaxy is a method used wherein a stone in
the bladder is crushed the fragments are washed
out through a catheter.
Q:
What is Tactile Litholapaxy?
A:
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.
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The following list of Urology procedures are
performed at Beverly Hills Medical Group -
please click the links to find out more:
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