Safety and efficacy of cystoscopically guided percutaneous suprapubic cystolitholapaxy without fluoroscopic guidance

Abstract

ObjectiveTo evaluate the safety and efficacy of percutaneous cystolitholapaxy (PCCL) under cystoscopic guidance and without fluoroscopy for the management of large or multiple bladder stones.Patients and methodsProspectively collected data were reviewed for patients undergoing PCCL with cystoscopic guidance and without fluoroscopy. Patients with a bladder stone burden of ⩾30 mm were included. Stone fragmentation was achieved using a pneumatic lithotripter through a rigid nephroscope and the fragments were removed with peanut forceps. Patients with concomitant bladder malignancy, previous pelvic radiotherapy, previous pelvic–abdominal surgery, or benign prostate enlargement of >80 mL were excluded from the study.ResultsIn all, 40 male patients were included between July 2011 and June 2014 with a mean (SD) age of 36.9 (17.6) years. A single bladder stone was detected in 22 (55%) patients, whilst 18 (45%) had multiple bladder stones, with a mean (range) stone size of 35 (32–45) mm. The stone-free rate was 100% and the procedure was well tolerated by all patients. No intraoperative bladder perforation, bleeding or major perioperative adverse events were recorded. The mean (SD) hospital stay was 2.2 (0.41) days and the catheterisation time was 1.2 (0.6) days. At 4 weeks postoperatively, no significant stone fragments were found in any of the patients.ConclusionPCCL under cystoscopic control and without fluoroscopy seems to be an effective and safe technique to remove large or multiple bladder calculi. It represents an alternative treatment option, especially in situations where fluoroscopy is not available, and radiation hazards can be avoided.

Retrograde-Assisted Percutaneous Cystolitholapaxy Versus Transurethral Cystolithotripsy With Holmium-YAG Laser: A Retrospective Study

“…On the other hand, classic bladder access is associated with the potential risk of dilatator over-advancement and damage to the posterior bladder wall and rectum during access to the bladder. 18,19 Although the risk of injury can be reduced by simultaneous cystoscopy or fluoroscopy, they have their own limitations. Simultaneous cystoscopy needs another urologist and fluoroscopy encompasses the patient's and surgeon's exposure to radiation.…”

“…Simultaneous cystoscopy needs another urologist and fluoroscopy encompasses the patient's and surgeon's exposure to radiation. 19 In the retrograde approach, there is not any chance of over-advancement since the dilatator enters the bladder under the control of the Benique, and also, no radiation or even cystoscopy is needed during the bladder access.…”

A new surgical technique: transvesical resection of prostate - case series

“…Open, transurethral and percutaneous cystolithotripsy are the most used methods for bladder stones ( 19 , 20 ). Recent publications report a preference of percutaneous over transurethral cystolithotripsy for bladder stones due to urinary stricture risks and shorter operation times ( 19 - 22 ). In this technique we developed, both surgeries can be percutaneously performed from the same entry point.…”