Preparing for your percutaneous
cystolitholapaxy (PCCL)
Welcome
We look forward to welcoming you to The Royal London Hospital. You have been referred to us for
percutaneous cystolitholapaxy (surgery to remove stones in the bladder). This leaflet will tell you
more about the procedure.
What is percutaneous cystolitholapaxy?
This is an operation to remove stones in the bladder, using ultrasonic waves or lasers. The stones
are formed by the crystallisation of salts in the urine. The stones are crushed into small pieces and
then removed from the body.
Why do I need this operation?
You may be getting symptoms such as pain or recurrent urine infections and this procedure will
help. Almost everyone who has stones in the bladder will need some sort of surgery to get rid
of them.
Tell me more about the bladder…
The bladder is a hollow, muscular organ situated in the lower part of your abdomen. It stores urine
that has been produced by your kidneys and then transported there via two ureters (pipes). When
the bladder is full enough, the urine will pass down the urethra (waterpipe) and out of your body,
into the toilet. In males, the urethra is quite long and passes through the prostate and down the
penis. In females, the urethra is much shorter and can be found immediately in front of the vagina.
What happens on the day of my appointment?
Please do not eat anything for six hours before your appointment.
You may continue to drink WATER ONLY up until two hours before your appointment.
When you arrive, we will ask you to sign a consent form, giving your permission for the operation to
go ahead. You may have already signed a consent form when the decision was made with you to
proceed with an operation, in which case we will reconfirm this with you.
We will give you a gown to put on and then you will have a general anaesthetic or a spinal
anaesthetic, depending on which is the safest method for you. The anaesthetist will discuss this
with you.
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What happens during the operation?
The surgeon will make a small cut below your belly button and a cystoscope (camera) will be
passed into your bladder and used to look at your stone. Sometimes we may need to pass the
camera through your urethra (waterpipe) and into your bladder. Once the stone has been located,
lasers or ultrasound waves will be used to break it up into small pieces. The pieces are then
washed out of the bladder.
What happens after the operation?
You will be taken from the theatre to the recovery room, where you will be closely monitored until
you are awake enough to return to the ward.
You may have a catheter (tube) inserted into your bladder (through the cut that was made for the
little camera). The tube will drain your urine and any blood or debris from the operation. It allows
the bladder to start healing. There is a very slim chance that you will also have a urethral catheter
in place (a tube inserted from the urethra into the bladder).
Your surgeon will let you know how long the tubes need to stay in for. The length of stay varies
from person to person and your doctor will discuss this with you when you have the procedure.
How will I feel when I go home?
It may be uncomfortable to pass urine for two to three days after you have been discharged
from hospital. It is important to drink plenty of fluids (about two litres a day) to help improve
these symptoms.
 If your symptoms last longer than a week or you are worried about anything else then
you should seek advice from your GP.
Will I still see blood in my urine?
You will probably see a little blood in your urine for a couple of weeks after the operation. It is
important to drink plenty of fluids to flush the bladder through and help it to heal.
 If the bleeding becomes heavy, and there are thick blood clots that block the flow of
urine, you should contact your GP straight away.
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How much should I drink?
For the first week, you should drink around two litres (five pints) every day. Drink mostly water. This
will help to wash away the blood and prevent infection. After this, you should try to maintain a fluid
intake of around 2-3 litres of fluid per day.
What happens if I get a urine infection?
Following the operation you are at risk of getting a urine infection.
 If you find that your urine becomes cloudy or smelly, and you have a burning
sensation on passing urine, then you should contact your GP, as you may need a course
of antibiotics.
Is it OK to take painkillers?
Seek medical advice within the hospital or from your GP before taking any new medication. Are there any risks or complications associated with this procedure?
General anaesthetics are very safe. However all operations carry some risks. With any surgery
there is a small chance that you will develop a chest infection, a clot in your lung or leg, bleeding
or heart problems. You will have the opportunity to discuss this with the anaesthetist before
your operation.
Complications and risks associated with percutaneous cystolitholapaxy include:
• Infection of the bladder requiring antibiotics
• Delayed bleeding requiring further surgery or scar formation in the urethra (very rare)
• Perforation of the bowel during the procedure which may then lead to open surgery
(very rare).
When can I go back to work?
You should be able to go back to work three to four weeks after the operation. You may need a
little more time if you have a manual job that requires heavy lifting or physical work. If you require a
statement of fitness to work certificate (sick certificate), you can collect one from the ward to cover
the time you spent in hospital. If you need one when you return home, you will be able to collect
one from your GP.
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Is it safe to exercise?
You should try and take things easy for the first 10 days after leaving hospital, keeping all physical
activity to a minimum. You should avoid any activities that involve lifting heavy objects for about six
weeks after leaving hospital.
Alternative treatment
Alternatives to this procedure include open surgery to remove the stone.
Who can I contact for further information about my procedure?
Please contact the Urology Nurse Specialist:
Department of Urology, 9th Floor, The Royal London Hospital, Whitechapel, London, E1 1BB
020 3594 2682. Fax: 020 3594 3225
Patient Advice and Liaison Service (PALS)
If you need general advice or support with our services, including help with any concerns you may
have, please contact the Patient Advice and Liaison Service (PALS) for The Royal London
Hospital: Tel: 020 3594 2050 or 020 3594 2040 Fax: 020 3594 3235
Large print and translations
To receive this leaflet in large print, please call the Patient Advice and Liaison Service (PALS) on
020 3594 2050 or 020 3594 2040.
If you would like help interpreting this leaflet, please call the Health Advocacy Administrator on
020 7377 7280.
Data Protection Act 1998
The Trust uses your personal information to help us provide you with high quality healthcare. Your health records could
also be used for teaching, training, audit and research. This is so that we can deliver the best possible care across the
Trust. Further information can be found on our website at www.bartshealth.nhs.uk
Reference: BH/PIN/58
Publication date: July 2012
All our patient information leaflets are reviewed every three years.
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