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Percutaneous Ultrasonic Cystolithalopaxy : A Novel Technique For Treating Large Bladder Calculi
Gopal N Gupta, James F. Borin
University of Maryland, Baltimore, MD
Introduction: We describe a novel percutaneous approach for the minimally invasive treatment of large (>4 cm) bladder stones.
Methods: The patient is a 37 year old male status post abdominal gunshot wound with multiple abdominal explorations requiring chronic indwelling foley catheter who subsequently developed a 5 cm bladder stone causing bladder outlet obstruction. Under cystoscopic visualization, a 10 mm laparascopic trocar was passed into the bladder through an existing suprapubic cystostomy site. A 10 mm laparoscopic entrapment sac was passed through the trocar and the stone was maneuvered into the sac via a flexible grasper. The edges of the sac were brought through the skin and the trocar was reintroduced into the sac. Ultrasonic lithotripsy was then performed through a nephroscope and the stone gravel extracted intact with the entrapment sac.
Results: Percutaneous removal of the entire stone burden was achieved. The entrapment sac was not perforated. The bladder mucosa was undisturbed. The total operative time was 129 minutes. The case was perfomed on an outpatient basis. At 1 month follow-up, the patient is voiding per urethra.
Conclusions: Percutaneous cystolithotomy using an ultrasonic lithotripter in a laparoscopic entrapment sac is a safe minimally invasive modification of contemporary percutaneous techniques for the treatment of large bladder calculi. It can be performed faster than standard laser cystolitholapaxy and avoids the need for a large incision in open cystolithotomy. The entrapment sac helps to avoid injury to the bladder mucosa, urethra and bladder neck, and obviates the need to chase small fragments
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