Minimally invasive bladder and urethral stone removal
Percutaneous cystolithotomy (PCCL) provides a minimally invasive way to remove stones from the bladder and urethra
The American College of Veterinary Internal Medicine recommends removing both bladder and urethral stones associated with clinical signs by minimally invasive procedures such as laser lithotripsy and/or percutaneous cystolithotomy (PCCL) instead of conventional surgery (cystotomy)
Bladder calculi can be removed via conventional surgery (cystotomy), percutaneous cystolithotomy (PCCL), or laser lithotripsy via cystoscopy.
Conventional surgery involves making an incision in the bladder to remove the calculi. It has been estimated that calculi are left behind approximately 20% of the time. 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.