David C Miller1, John M Park. 1. Department of Urology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
Abstract
OBJECTIVES: To describe a percutaneous approach that uses laparoscopic techniques and technology to achieve intact removal of bladder stones after augmentation cystoplasty. METHODS: Percutaneous stone removal using a laparoscopic entrapment sac was performed in 4 patients with augmented bladders. Under endoscopic guidance, a 10-mm laparoscopic trocar was placed percutaneously into the augmented bladder using the previous suprapubic tube site. The stones were then maneuvered into a laparoscopic entrapment sac and extracted intact without lithotripsy. RESULTS: Percutaneous removal of the entire stone burden (up to seven stones in 1 patient) was achieved in 3 of 4 patients. The total operative time was less than 1 hour in each of these cases. Partial conversion to open cystolithotomy was required in 1 patient, because of tearing of the entrapment sac. Three of 4 cases were performed on an outpatient basis and less than 24 hours of catheter drainage was required in all but 1 patient. CONCLUSIONS: Percutaneous cystolithotomy using a laparoscopic entrapment sac is a safe, useful, and minimally invasive modification of contemporary percutaneous techniques. In patients with augmented bladders, application of this technique may minimize the risk of residual fragments and obviate the need for adjuvant lithotripsy.
OBJECTIVES: To describe a percutaneous approach that uses laparoscopic techniques and technology to achieve intact removal of bladder stones after augmentation cystoplasty. METHODS: Percutaneous stone removal using a laparoscopic entrapment sac was performed in 4 patients with augmented bladders. Under endoscopic guidance, a 10-mm laparoscopic trocar was placed percutaneously into the augmented bladder using the previous suprapubic tube site. The stones were then maneuvered into a laparoscopic entrapment sac and extracted intact without lithotripsy. RESULTS: Percutaneous removal of the entire stone burden (up to seven stones in 1 patient) was achieved in 3 of 4 patients. The total operative time was less than 1 hour in each of these cases. Partial conversion to open cystolithotomy was required in 1 patient, because of tearing of the entrapment sac. Three of 4 cases were performed on an outpatient basis and less than 24 hours of catheter drainage was required in all but 1 patient. CONCLUSIONS: Percutaneous cystolithotomy using a laparoscopic entrapment sac is a safe, useful, and minimally invasive modification of contemporary percutaneous techniques. In patients with augmented bladders, application of this technique may minimize the risk of residual fragments and obviate the need for adjuvant lithotripsy.