Complications of Endoscopic Cystolithotomy
Cystolithotomy Cluster · Silo Endoscopy · Colombia 2026
Complications of endoscopic cystolithotomy: what they are, how to prevent and treat them
Endoscopic cystolithotomy has a complication rate of 5–10% — most are minor. Complete clinical guide on the most frequent complications, their risk factors and the management protocol
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GSMED Imaging medical team — urological endoscopy Colombia
Based on: EAU Guidelines on Urolithiasis 2025, Clavien-Dindo classification of surgical complications, Journal of Endourology (Complications of cystolithotripsy 2023) and endoscopic complication management protocols from HIC Colombia.
ℹ️ Medical notice: If after your cystolithotomy you experience fever >38°C, severe pain, inability to urinate, heavy bleeding or intense general malaise — consult your urologist urgently or go to the emergency room. Do not wait for the next appointment.
Endoscopic cystolithotomy is a safe procedure — but like any surgical intervention, it has possible complications that the patient and medical team must know, anticipate and manage. The overall complication rate reported in the literature is 5–10%, with most being minor and resolving spontaneously.
1. Classification of complications — Clavien-Dindo system
The Clavien-Dindo system classifies surgical complications according to the treatment they require — not according to their subjective severity. This classification is the international standard for reporting endoscopic complications:
| Clavien Grade | Definition | Example in cystolithotomy | Frequency |
|---|---|---|---|
| Grade I | Deviation from the normal course — without active treatment | Mild postoperative hematuria that resolves on its own · Fever <38°C | 20–30% |
| Grade II | Requires pharmacological treatment (antibiotic, transfusion, etc.) | Urinary tract infection requiring antibiotics · Hematuria requiring irrigation | 5–10% |
| Grade IIIa | Requires procedure under local anesthesia | Urethral catheter placement for urinary retention · Replacement of obstructed catheter | 1–3% |
| Grade IIIb | Requires procedure under general anesthesia | Re-endoscopy for symptomatic residual fragments | <1% |
| Grade IV | Life-threatening — ICU | Urinary sepsis · Bladder perforation with extravasation | <0.5% |
2. The 6 most frequent complications
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Hematuria (blood in urine)
The most frequent — expected in all patients in the first 24–72 hours. The urine initially pink or red gradually clears. Mild hematuria is normal and does not require intervention. Hematuria that darkens, with clots or that does not improve in 72 h requires evaluation. Treatment: abundant hydration, continuous bladder irrigation if intense. Risk factors: anticoagulants, large stone, inflamed mucosa.
→ Grade I–II · Normal for the first 72 h · Watch if it worsens
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Post-procedure urinary tract infection
Occurs in 3–8% of cases despite antibiotic prophylaxis. Risk factors: previous untreated urinary tract infection, diabetes, immunosuppression, prolonged urinary catheter, infected stone (struvite). It manifests with fever, chills, burning during urination and cloudy urine. Treatment: urine culture + oral antibiotic according to sensitivity. If sepsis: hospitalization + IV antibiotic.
→ Grade II · Urine culture + antibiotic · Hospitalize if sepsis
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Acute urinary retention
Inability to urinate after the catheter is removed — due to sphincter spasm, urethral edema or residual fragments that obstruct the bladder neck. Occurs in 2–5% of cases. Treatment: temporary urethral recatheterization (additional 24–48 h), alpha-blocker (tamsulosin) to relax the bladder neck. If retention persists, consider follow-up cystoscopy to rule out obstructive fragments.
→ Grade IIIa · Recatheterization + alpha-blocker
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Bladder reabsorption syndrome
Absorption of hypotonic irrigation fluid (glycine) into the bloodstream due to excessive irrigation pressure or undetected bladder perforation. Produces hyponatremia, hypervolemia, hypotension and confusion. Rare with correct technique and monitoring. More frequent with resectoscope than with continuous irrigation cystoscope. Treatment: correction of hyponatremia + diuretics.
→ Grade III–IV · Prevention: control irrigation pressure
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Bladder perforation
Very rare with pure cystolithotomy (<0.5%) — more frequent if simultaneous prostate surgery is performed. It can be intraperitoneal (serious — abdominal pain, ileus) or extraperitoneal (generally conservative management with catheter). The urologist recognizes it during the procedure by seeing perivesical fat or noticing extravasation of the irrigation fluid.
→ Grade III–IV · Recognize intraoperatively · Surgery if intraperitoneal
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Residual fragments (residual lithiasis)
Stone fragments that remain in the bladder after the procedure. In small fragments (<3 mm), they usually pass spontaneously with urine. Larger fragments or those that cause symptoms (hematuria, infection, difficulty urinating) require re-endoscopy. Systematic evacuation with the Ellik Evacuator at the end of the procedure significantly reduces this complication.
→ Grade I–IIIb · Ellik evacuation reduces risk · Re-endoscopy if symptomatic
3. Post-cystolithotomy warning signs — when to call the doctor
Consult urgently if you experience any of these symptoms → Fever greater than 38°C with chills (possible urinary tract infection/sepsis) → Inability to urinate after the catheter is removed (urinary retention) → Heavy bleeding with clots that obstruct the catheter → Severe or generalized abdominal pain (possible bladder perforation) → Mental confusion or unexplained drowsiness (possible reabsorption syndrome) → Urine that does not clear after 72 hours from surgery
When can I urinate normally after cystolithotomy?
The urethral catheter is generally removed 24–48 hours after the procedure, when the hematuria has cleared sufficiently. After catheter removal, it is normal to feel burning during urination for 2–5 days (urethral irritation from the catheter), urgency and increased frequency. These symptoms gradually improve. If intense burning or severe urgency persists after 7 days, consult your urologist to rule out infection or urethral inflammation.
Endoscopic systems for cystolithotomy in Colombia — GSMED
Olympus and Karl Storz HD cystoscopes with complete instrumentation and local technical support.
View cystoscopy systems →
