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RID - Vesicolithotomy

This document discusses vesicolithotomy, which is the surgical removal of bladder stones. Key points include: - It involves making an incision in the bladder to remove stones larger than 2cm, hard stones that can't be broken up, or multiple stones. - Equipment used includes surgical instruments like forceps, clamps, and retractors. X-rays are used to locate the stones. - The procedure involves making an abdominal incision, opening the bladder, removing the stones using forceps, inspecting the bladder, closing the bladder with sutures, and placing a drainage catheter. - Potential complications include bleeding, damage to other organs, and infections. Post-operative care involves

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Dwiyanti Oktavia
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799 views30 pages

RID - Vesicolithotomy

This document discusses vesicolithotomy, which is the surgical removal of bladder stones. Key points include: - It involves making an incision in the bladder to remove stones larger than 2cm, hard stones that can't be broken up, or multiple stones. - Equipment used includes surgical instruments like forceps, clamps, and retractors. X-rays are used to locate the stones. - The procedure involves making an abdominal incision, opening the bladder, removing the stones using forceps, inspecting the bladder, closing the bladder with sutures, and placing a drainage catheter. - Potential complications include bleeding, damage to other organs, and infections. Post-operative care involves

Uploaded by

Dwiyanti Oktavia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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VESICOLITHOTOMY

Farid Setyono, dr
Definition

Incision of the bladder for removal of a


calculus.

(Dorland's Medical Dictionary for Health Consumers, 2007)


Anatomy and Physiology

(Clinical anatomy by regions 8 th editions, 2010)


Anatomy and Physiology

(Clinical anatomy by regions 8 th editions, 2010)


Indication
Stone size > 2cm
Hard bladder stones that can not be solved
with a lithotriptor
Multiple bladder stone
Not obtained access through the urethra
Concomitant open prostatectomy or
diverticulectomy

(SOP Urologi, 2007)


Contraindications
Suspicious of bladder malignancy
Unclear cause of gross hematuria
Bleeding disorder

(Campbell,10th ed)
Equipment

Pinset anatomis and


Pinset chirrurgis scapel handle
Equipment

Kocher
Mosquito Clamp
Equipment

Ellis Sharp Spreader


Equipment

Double
langenback Needle Holder
Equipment

Spreader millin
Suction Tip
Equipment

Doek Clamp
Equipment

Catheter and Speed


Suction Drain mash
Equipment

Stone Tang (Stein tang)


Procedures
Marking operation site 1 day before
Informed Consent
Patient in general anesthesia or spinal block.
Operator in the left patient for right handed.
Patient in supine position, lift the lower back if
needed.

(Hinmans Atlas of Urologic Surgery,3rd ed)


Procedures
Taken X-ray on viewer
Desinfects the abdomen, penis, and both
inner thigh with Povidone Iodine 10%
Cover it with sterile drappings.
Reading patients checklist

(Hinmans Atlas of Urologic Surgery,3rd ed)


Procedures
Draw the incision
design
Make the incision 2
finger upper
symphisis pubis
Open layer by layer

(Hinmans Atlas of Urologic


Surgery,3rd ed)
Procedures

Incise the fascia transversely


widened with the scissors

(Hinmans Atlas of Urologic Surgery,3rd


ed)
Procedures

Enter between the recti and separate them bluntly.


Hold the muscles back with two retractors to
expose the prevesical fat.

(Hinmans Atlas of Urologic Surgery,3rd


ed)
Extraperitoneal fat and
peritoneum overlying
the bladder seen

Reflect the peritoneum


upward with gauze
piece

(Hinmans Atlas of Urologic Surgery,3rd ed)


Identify the bladder
Place two 3- 0 chromic catgut (CCG) stay
sutures into the bladder wall well above the
symphysis.

(Hinmans Atlas of Urologic


Surgery,3rd ed)
Procedures

With suction at hand,incise the bladder


vertically between the sutures with the
metzenbaum, and enter the bladder.
quickly replace it with the tip of the suction.

(Hinmans Atlas of Urologic


Surgery,3rd ed)
Procedures
Enlarge the opening
Grasp the stone with stone tang and remove it
(evaluate the size, color, and number of
stone).

(Hinmans Atlas of
Urologic Surgery,3rd
ed)
Washout the bladder cavity with normal saline
Evaluate the bladder wall
(for tumor or diverticle), the ureter ends (for stones
and ureteric jet), and size of bladder neck. Inspect
the base of the bladder for other stones.
Take specimen for bladder biopsy if the size of
the stone is more than 3 cm.
Evaluate the prostate through the bladder
neck
Procedures
Washout the bladder cavity through the
catheter.
Close the bladder with a running 3-0 plain
catgut suture applied to the muscularis
mucosal layer.
Reinforce it with interrupted sutures of 3-0
polyglactin placed through the
seromuscularis.
Fill the bladder with 250 cc of normal saline
through urethral catheter, evaluate if there is
any leaks within the sutures.
Leave the catheter in place secure it with 10
cc of sterile water.
Put the draine on cavum retzii and fixation the
draine
Procedures

Place a small suction drain (paravesical) to


exit through the wound for a few days.
Stitch layer by layer
fascia of rectus abdominis muscle with
polyglactin 1-0
subcutaneous tissue with plain catgut 3-0
the skin with stepler
Close the wound with tulle and sterile gauze.

(Hinmans Atlas of Urologic


Surgery,3rd ed)
Complications

Intraoperativ
Early Postop Late Postop
e
Bleeding Bleeding Peritonitis
False route Infection Other
to peritoneal infections
cavity Fistules
Damage to
other
intraabdomin
al organs

(Campbell,10th
ed.2004)
Post Surgical Care
Remove the catheter after day 7.
Remove the drain after 2 day remove the
catether when the production is minimal (<20
cc/24 hour).
Analyze the composing material of the stone.

(Campbell,10th ed. 2004)


TERIMAKASIH

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