Bladder stone - PCCLT &PUCLT

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Bladder stone - PCCLT &PUCLT

Bladder stones are hard mineral deposits that form in the bladder, often due to incomplete bladder emptying, urinary stasis, or foreign bodies. For the surgical removal of bladder stones, two minimally invasive techniques are commonly used: PCCLT (Percutaneous Cystolithotripsy) and PUCLT (Per-Urethral Cystolithotripsy). Here's an overview:

Percutaneous Cystolithotripsy (PCCLT)

PCCLT involves creating a small incision in the lower abdomen to directly access the bladder and remove the stone.

Indications:

  • Large bladder stones (>2–3 cm).
  • Stones that cannot be fragmented or removed via the urethra.
  • Patients with urethral strictures or anatomical abnormalities preventing PUCLT.

Procedure:

  1. Anesthesia: Usually performed under general or regional anesthesia.
  2. Access: A small incision is made in the lower abdomen to access the bladder.
  3. Fragmentation and Removal:
    • A nephroscope or cystoscope is inserted into the bladder.
    • The stone is fragmented using ultrasonic, pneumatic, or laser energy.
    • Fragments are removed through the percutaneous tract.
  4. A catheter may be placed temporarily for drainage.

Advantages:

  • Direct access to large stones.
  • High stone clearance rate in one session.
  • Avoids potential urethral trauma.

Disadvantages:

  • Requires a small incision.
  • Slightly longer recovery time compared to PUCLT.
  • Risk of bleeding, infection, or bladder injury.

Per-Urethral Cystolithotripsy (PUCLT)

PUCLT involves removing bladder stones via the urethra using an endoscope, without any external incision.

Indications:

  • Smaller bladder stones (<2–3 cm).
  • Stones that can be accessed easily through the urethra.
  • Patients without significant urethral or anatomical abnormalities.

Procedure:

  1. Anesthesia: Typically performed under general or local anesthesia.
  2. Access: A cystoscope is inserted through the urethra into the bladder.
  3. Fragmentation and Removal:
    • Stones are fragmented using laser or pneumatic energy.
    • Fragments are extracted through the urethra.
  4. A catheter may be placed temporarily after the procedure.

Advantages:

  • Minimally invasive with no external incision.
  • Short recovery time.
  • Suitable for most patients without complicating factors.

Disadvantages:

  • Risk of urethral injury or strictures.
  • Limited suitability for very large stones or anatomical abnormalities.

Comparison of PCCLT and PUCLT

Feature PCCLT PUCLT
Stone Size >2–3 cm <2–3 cm
Access Small abdominal incision Through the urethra
Invasiveness Minimally invasive Non-invasive
Recovery Time Moderate Short
Stone Clearance High in one session Effective for smaller stones
Risks Bleeding, infection, bladder injury Urethral trauma, infection

Post-Procedure Care

  • Hydration: Drink plenty of fluids to flush out residual fragments.
  • Medications: Antibiotics to prevent infection and pain relievers if needed.
  • Catheter Care: If a catheter is placed, follow instructions for maintenance and removal.
  • Lifestyle Changes: Dietary adjustments to prevent recurrence (e.g., reducing oxalate or calcium intake).

Follow-Up

  • Imaging studies (e.g., ultrasound, X-ray) to ensure complete removal of stones.
  • Evaluation for underlying conditions like bladder outlet obstruction, infections, or neurogenic bladder.

If you have more questions or need specific details about either procedure, feel free to ask!