Flexible cystoscopy and laser stone fragmentation via Mitrofanoff stoma: A case series

Abstract

Objective: This case series aimed to demonstrate that flexible cystoscopy and laser stone fragmentation via a Mitrofanoff stoma is possible and an effective treatment for symptomatic bladder stones in complex patients with inaccessible urethras and challenging anatomy. Patients and methods: We present three cases which were managed in a tertiary centre. The procedure involved using a flexible cystoscope via the Mitrofanoff stoma and laser stone fragmentation without the need for an access sheath. Results: This technique was performed safely and demonstrated successful bladder stone clearance on follow-up, with no postoperative complications. Conclusion: Our case series illustrates a technique that can be performed in this select group of patients in specialist centres with the relevant surgical exposure and expertise. Level of evidence Level 4.

Re: Flexible cystoscopy and laser stone fragmentation via Mitrofanoff stoma: A case series (Conway et al., J Clin Urol Feb 21)

“…It is mentioned that the latter two patients had a history of vesicocutaneous fistulae following percutaneous cystolithotomy and open cystolithotomy. 1 All three cases did not require an access sheath, were covered with antibiotics and were performed safely, with the latter two done on a day-case basis. 1 The authors are to be commended on yet another technique to facilitate bladder stone removal in the neurogenic bladder patient with a surgically reconstructed conduit mechanism, an inaccessible urethra and nondependent bladder drainage.Neurogenic patients with an inaccessible urethra pose challenges for the urologist, as they do not have dependent bladder drainage.…”

“…1 All three cases did not require an access sheath, were covered with antibiotics and were performed safely, with the latter two done on a day-case basis. 1 The authors are to be commended on yet another technique to facilitate bladder stone removal in the neurogenic bladder patient with a surgically reconstructed conduit mechanism, an inaccessible urethra and nondependent bladder drainage.Neurogenic patients with an inaccessible urethra pose challenges for the urologist, as they do not have dependent bladder drainage. 2 Multiple hybrid techniques have been developed to achieve stone clearance in neurogenic patients with enterocystoplasties, urinary diversions or Mitrofanoff bladders.…”