Percutaneous intervention of large bladder calculi in neuropathic voiding dysfunction

Abstract

Purpose: To report our results and rationale for treating large bladder calculi in patients with neuropathic voiding dysfunction (NVD) using percutaneous cystolithalopaxy. Materials and Methods: Ten patients with a previously diagnosed NVD presenting with a large stone burden were identified from our department database and a retrospective review of case notes and imaging was performed. Results: Percutaneous access to remove bladder stones (range 8x7 to 3x2 cm) had a mean surgery length of 150 min and blood loss of 23 mL. Six of the seven patients treated percutaneously were discharged on the day of surgery and suffered no complications, while one patient experienced poor suprapubic tube drainage and required overnight admission with discharge the following day. Transurethral removal of stone burden (range 4x4 to 4x3 cm) had a mean surgery length of 111 min and blood loss of 8 mL. Each of these three patients were under our care for less than 23 hours, and one patient required a second attempt to remove 1x0.5 cm of stone fragments. There was no statistical difference between mean operative times and estimated blood loss, p = 0.5064 and p = 0.0944 respectively, for the two treatment methods. Conclusion: In this small series, percutaneous cystolithalopaxy was a safe, effective, and often preferred minimally invasive option for removal of large calculi in patients with NVD. We suggest possible guidelines for best endoscopic approach in this population, although a larger and prospectively randomized series will be ideal for definitive conclusions.

Predictors of clinical and surgical characteristics of giant stones of the urinary bladder: a retrospective study

“…Regarding the significant association of the solitary GSBs with a higher incidence of iLUTS, when compared to the multiple GSBs, we believe that this significat association might be attributed to the common incidence of the single GSBs [ 5 , 7 ]. In addition, the multiple GSBs are usually associated with detrusor hypoactivity rather than detrusor overactivity, indicating a lower incidence of iLUTS [ 21 , 24 ]. However, the effect of the stone size on the occurrence of iLUTS in our results was mostly due to the foreign body-like effect, leading to mucosal irritation and inflammation that were described in the previous cases [ 2 , 22 ].…”

The treatment of larger bladder stones using of nephroscope via transurethrally

“…Bladder calculi are one of the most common entities of stones occurring in the urinary tract, and, unlike kidney or ureter stones, most occur because of conditions unrelated to calculi (1). Reported risk factors for developing bladder stones include patient age, type of augmented diversion, immobilization contributing to hypercalciuria and oxalate calcium stone formation, and infected urine (2). Massive or giant bladder calculus is a rare entity in the recent urological practice.…”