Minimally invasive bladder and urethral stone removal
Percutaneous cystolithotomy (PCCL) provides a minimally invasive way to remove stones from the bladder and urethra
Reasons to avoid cystotomy
1 in 5 patients has incomplete stone removal (stones left behind)
Potential suture reactions lead to prolonged (months) urinary discomfort
Bladder stones can move into urethra and become lodged
Sutures can become a nidus for stone formation, leading to recurrent stones
Bladder calculi can be removed via conventional surgery (cystotomy), or minimally invasive approaches such as percutaneous cystolithotomy (PCCL) and laser lithotripsy via cystoscopy.
Conventional surgery involves making an incision in the bladder to remove the calculi. A study evaluating patients post-cystotomy revealed that calculi are left behind approximately 20% of the time. Incomplete stone removal defeats the purpose of the stone removal. It is much more difficult for a stone to naturally recur than to expand from an existing stone, thus the importance of removing all stones during the stone removal procedure.
Also, approximately 9.4% of dogs (and 4% of cats) with recurrent calculi had suture material associated with the recurrent calculi. Therefore, minimizing suture material can help prevent recurrent bladder calculi.
Removal of both bladder and urethral stones (calculi) via PCCL
Percutaneous cystolithotomy is a minimally invasive form of removing bladder calculi. It entails making a small abdominal incision to expose the bladder. Then, a stab incision (6 mm) is made into the bladder to allow the cystoscope to evaluate the bladder and remove the calculi. The magnified evaluation via scope significantly decreases the chances of calculi being left behind. It is estimated that only 3.7% of the time calculi are left behind after a PCCL.
In the initial PCCL study, there was one patient that had a fragment of a stone left behind post PCCL because the calculus fragmented on the way out, and a re-evaluation of the bladder was not performed. With re-evaluation of the bladder, calculi should not be left behind. The magnification of the cystoscope and saline flushing provides a great visualization of the bladder and urethra making it very unlikely for stones to be left behind.
Removal of bladder and urethral silica stones from a dog via PCCL. You can see the damage caused by the stones lodged in the urethra. The urethral stones were removed retrograde through the bladder. There was no need to use the laser to remove them despite being lodged into the mucosal wall.
PCCL and laser lithotripsy
Laser lithotripsy can be used fragment large stones in order to make it smaller allowing it to be removed through the 6 mm Endotip port.
Radiograph of dog with large bladder stone
Ultrasound of dog with large bladder stone
Laser lithotripsy via PCCL
Post-op radiograph of dog after removing a large bladder stone
Most dogs and cats undergoing a PCCL procedure will go home the same day of the procedure with minimal to no urinary signs.