Giant pouch calculus: A surgical challenge

Letter to the Editor re: Giant pouch calculus: a surgical challenge

“…8 Specific to Indiana pouch stones, a modified technique using a flexible cystoscope and a laparoscopic trochar to anchor the stone, thus permitting fragmentation with an electrohydraulic lithotripter, has been described by Jarrett et al 9 The authors allude to the potential damage to reconstructed surgical anatomy and the time involved when using endoscopic techniques to achieve stone removal via the catheterisable channel. 1 However, Mitrofanoff cystolitholopaxy (the Leighton Transstomal Technique) using a modified Add-A-Cath sheath backloaded onto a flexible cystoscope and subsequent lasertripsy has been described in a spina bifida patient with an ablated urethra. 10 Although time consuming, it permitted repeated atraumatic access to the bladder without any damage to the mitrofanoff stoma, and allowed the safe use of a retrieval basket.…”

“…12,13,14 The case described by Singh et al is notable for employing a modified technique to protect the pouch wall during stone removal as stone size required open pouchlithotomy. 1 The authors are to be congratulated on this novel technique using the Deavers retractor. Undoubtedly, in the neurogenic or diverted patient, any technique that is safely reproducible with minimal effects on reconstructed or aberrant anatomy is desirable.…”

“…We read with interest the recent publication by Singh et al 1 A case is presented of a 26-year-old epispadias-exstrophy male with an Indiana pouch who presented with a large stone in the continent diversion. The diagnostic work up and innovative surgical management of a 953 g stone is described.…”