Preparation for Cystolithotomy: A Complete Guide
Cystolithotomy Cluster · Endoscopy Silo · Colombia 2026
Preparation for endoscopic cystolithotomy: a complete guide for the patient
What to do in the days leading up to cystolithotomy, what preoperative tests you need, how many hours to fast, which medications to adjust, and what to bring on the day of surgery
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GSMED Imaging medical team — urological endoscopy Colombia
Based on: preoperative anesthesia guidelines (ASA 2023), EAU Guidelines Urolithiasis 2025, urological preoperative preparation protocols of HIC Colombia and Clínica Marly, and perioperative nursing literature on cystolithotomy.
ℹ️ Medical notice: This guide is for general reference. Specific preparation instructions for your cystolithotomy must come from your urologist and the anesthesia team at the institution where the procedure will be performed. Do not modify medications without consulting your doctor.
A well-prepared cystolithotomy is a safe cystolithotomy. The preparation steps — preoperative tests, medication management, proper fasting, and patient information — are as important as the surgical technique to ensure an optimal outcome and a recovery without complications.
1. Preoperative evaluation — the necessary tests
| Test | Why it is necessary | When to request it |
|---|---|---|
| Urine culture | Mandatory — detects active urinary tract infection that must be treated before surgery to prevent intraoperative bacteremia | 2–4 weeks before |
| Complete blood count | Rule out anemia, thrombocytopenia, or leukocytosis | 1–2 weeks before |
| Creatinine and BUN | Baseline renal function — especially if there is associated ureteral obstruction | 1–2 weeks before |
| Coagulation (PT/INR, PTT) | Mandatory if the patient takes anticoagulants or antiplatelet medications | 1–2 weeks before |
| Electrocardiogram (ECG) | Patients >50 years or with known heart disease — fit for anesthesia | 1–2 weeks before |
| Urinary tract ultrasound | Confirm bladder stone location and size and evaluate the upper urinary tract | 2–4 weeks before |
| Urinary tract CT scan (without contrast) | If the ultrasound does not fully characterize the stone or there is suspicion of associated ureteral stones | According to clinical indication |
2. Medication management prior to cystolithotomy
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Anticoagulants and antiplatelet medications
This is the most critical point. Oral anticoagulants (warfarin, rivaroxaban, apixaban, dabigatran) and antiplatelet medications (aspirin, clopidogrel) increase the risk of intraoperative bleeding. The urologist and cardiologist must coordinate the suspension protocol: warfarin generally 5 days before (with an LMWH bridge if indicated); DOACs 2–3 days before; aspirin 5–7 days before if cardiovascular risk allows. Never suspend on your own without consulting.
→ Coordinate with the urologist and cardiologist · Do not suspend without medical indication
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Prostate medications (alpha-blockers)
If the bladder stone is secondary to prostatic obstruction, the patient is likely taking tamsulosin, alfuzosin, or silodosin. These medications should be continued until the day of surgery — they help relax the urethra and facilitate cystoscopy. The anesthesiologist must know about them because they cause orthostatic hypotension.
→ Continue until surgery · Inform the anesthesiologist
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Prophylactic antibiotics
The 2025 EAU guidelines recommend antibiotic prophylaxis for cystolithotomy — generally a single dose of a fluoroquinolone or first-generation cephalosporin 30–60 minutes before the procedure. If the previous urine culture showed bacterial growth, it should be treated with the specific antibiotic for at least 48–72 hours before surgery, and a follow-up urine culture should be repeated.
→ Single dose 30–60 min before · Treat previous infection if present
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Chronic medications
Most chronic medications (antihypertensives, oral antidiabetics, thyroid medications) can be taken on the morning of surgery with a sip of water, except: metformin (suspend 24–48 h before if iodinated contrast will be used), insulin (adjust the dose according to each institution's protocol for a fasting patient).
→ Most: take with a sip of water · Metformin and insulin: adjust
3. Preoperative fasting — updated guidelines
ASA 2023 fasting guidelines — what has changed The updated guidelines from the American Society of Anesthesiologists (ASA 2023) are less restrictive than previous ones. For elective surgery under general or spinal anesthesia: clear liquids (water, juice without pulp, coffee without milk) up to 2 hours before the procedure — an 8-hour liquid fast is no longer necessary. Solids: 6 hours before (light meal) or 8 hours (meal with fat/protein). However, each institution may have its own protocols — always follow the instructions of your hospital.
| Type of intake | Minimum fasting (ASA 2023) | Example |
|---|---|---|
| Clear liquids | 2 hours | Water, tea without milk, black coffee, juice without pulp, isotonic drinks |
| Breast milk (neonates) | 4 hours | For infants only |
| Formula milk / cow's milk | 6 hours | Considered solid due to slower gastric emptying |
| Light meal | 6 hours | Toast with jam, fruit · No fat or protein |
| Full meal (fat/protein) | 8 hours | Meat, cheese, fried foods · Slower gastric emptying |
4. The day of cystolithotomy — what to bring and what to expect
- Arrive 1–2 hours before the scheduled time — to complete registration, the anesthesia evaluation, and the preparation of the surgical area (suprapubic and perineal shaving if required).
- Bring an adult companion who can take you home — spinal or general anesthesia prevents driving on the day of the procedure.
- Comfortable and loose clothing — especially around the lower abdomen and perineum. This facilitates catheter placement and subsequent walking.
- Necessary documents: health insurance card or policy, ID card, laboratory results and preoperative tests if not submitted earlier, current medication list.
- Do not bring jewelry or valuables — they must be stored before the procedure.
- Report allergies — especially to antibiotics, latex, iodinated contrast, or local anesthetics.
Can I work the day before cystolithotomy?
Yes. There are no work activity restrictions the day before endoscopic cystolithotomy. The only relevant restriction is compliance with the fast from the time agreed upon with the anesthesia team. It is recommended to avoid alcohol 48 hours before (it may interact with anesthesia) and intense physical exercise the day before (due to the risk of dehydration).
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HD equipment for endoscopic cystolithotomy with local technical support — GSMED Colombia.
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