2008 Annual Meeting Abstracts
Percutaneous Cystolithopaxy In Reconstructed Bladders: The Role Of CT-guided Access
Michelle Jo Semins, Brian R Matlaga
Johns Hopkins University School of Medicine, Baltimore, MD
Introduction: Patients who have undergone augmentation cystoplasty or continent urinary diversion are at increased risk for the development of bladder calculi. Although minimally invasive treatments, such as percutaneous cystolithotomy, may be less morbid than an open approach, in many cases percutaneous access by standard techniques would be unsafe due to the proximity of adjacent structures. Herein, we review our experience with CT-guided access for percutaneous cystolithopaxy in this group of patients.
Methods: Between July 2006 through March 2008, 9 patients with calculi in urinary diversions or augmented bladders underwent percutaneous cystolithopaxy. The mean stone size was 5.2 cm (range 1.2 -8.1 cm); 5 patients had multiple stones, and 4 patients had solitary stones. In all cases, percutaneous access was achieved with CT-guidance. A standard balloon dilator was used to place a 30 French sheath, and cystolithopaxy was performed with an offset nephroscope and ultrasonic or ballistic lithotripsy.
Results: In all cases percutaneous access was achieved without complication. Mean operative time was 78 minutes; there were no intraoperative complications. Mean length of hospitalization was 2.3 days. Post-operatively, one patient developed a UTI that was managed with antibiotic therapy.
Conclusions: CT-guided access for the percutaneous treatment of calculi in augmented bladders or urinary diversions is an effective approach for this complex group of patients. The benefit of axial imaging is its ability to define a safe pathway from the skin to the stone, an important consideration in these patients who have all undergone multiple prior abdominal surgeries.
