What are the key components of post-operative care for cystolithopaxy?

Post-Operative Care Plan for Cystolithopaxy

The post-operative care plan for cystolithopaxy should include urinary catheter management, pain control, early mobilization, and monitoring for complications, with catheter removal typically after 24-48 hours if no contraindications exist. 1

Immediate Post-Operative Care

Urinary Drainage Management

• Remove transurethral catheter within 24-48 hours after procedure if no contraindications 1, 2
• Some approaches may use a suprapubic catheter instead of urethral catheterization 2
• If a suprapubic catheter was placed, clamp it after 48 hours and remove after 2-3 normal voids 2

Pain Management

• Implement multimodal analgesia to minimize opioid use:
  • Acetaminophen scheduled dosing (if no contraindications)
  • NSAIDs (if no contraindications)
  • Consider local anesthetic techniques if appropriate 1
• Avoid excessive opioids which can contribute to postoperative ileus 1

Fluid and Electrolyte Management

• Monitor and correct electrolyte disturbances 1
• Use balanced crystalloids rather than normal saline for IV fluids 1
• Maintain adequate hydration to ensure good urine output and help flush any residual stone fragments

Monitoring and Complication Prevention

Infection Prevention

• Continue antimicrobial prophylaxis as indicated based on preoperative culture results
• Monitor for signs of urinary tract infection or urosepsis (fever, flank pain, cloudy urine) 3
• Ensure adequate fluid intake to maintain good urine output

PONV Management

• Implement multimodal PONV prophylaxis as cystolithopaxy patients are at high risk 1
• Consider scheduled antiemetics for the first 24 hours

Mobilization

• Encourage early mobilization within 2 hours post-procedure if possible 1
• Aim for 6 hours out of bed by postoperative day 1 1

Discharge Planning and Follow-up

Discharge Criteria

• Successful trial of void after catheter removal
• Adequate pain control with oral medications
• No signs of infection or significant hematuria
• Able to ambulate independently

Follow-up Plan

• Schedule follow-up visit within 2-4 weeks
• Consider urine culture if symptomatic
• Imaging may be indicated if incomplete stone clearance is suspected

Patient Education

• Instruct on adequate fluid intake (2-3 liters daily)
• Educate about signs of complications requiring urgent attention:
  • Severe pain unrelieved by prescribed medications
  • Fever >38°C
  • Inability to void
  • Significant hematuria or clots

Special Considerations

Pediatric Patients

• Children may require modified pain management approaches 4, 5
• Hospital stay may be shorter with percutaneous approaches compared to open procedures 4

Patients with Urethral Strictures

• More vigilant monitoring for urinary retention after catheter removal
• Consider longer catheterization if there is concern about urethral trauma during the procedure 4

By implementing this comprehensive post-operative care plan, you can optimize outcomes and minimize complications following cystolithopaxy procedures.