1047 PERCUTANEOUS CYSTOLITHOPAXY FOLLOWING COMPLEX LOWER URINARY TRACT RECONSTRUCTION: THE ROLE OF CT-GUIDED ACCESS

Abstract

You have accessJournal of UrologyPediatrics: Stone Disease1 Apr 20101047 PERCUTANEOUS CYSTOLITHOPAXY FOLLOWING COMPLEX LOWER URINARY TRACT RECONSTRUCTION: THE ROLE OF CT-GUIDED ACCESS Anthony J. Schaeffer, John P. Gearhart, and Brian R. Matlaga Anthony J. SchaefferAnthony J. Schaeffer More articles by this author , John P. GearhartJohn P. Gearhart More articles by this author , and Brian R. MatlagaBrian R. Matlaga More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2158AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Children who have undergone complex lower urinary tract reconstruction are at increased risk for bladder calculi. Although minimally invasive percutaneous treatments may be less morbid than open surgery, access to the bladder by standard techniques may be unsafe due to the proximity of adjacent structures. Herein, we review our experience with CT-guided access for percutaneous cystolithopaxy among these patients. METHODS Between March 2008 and November 2009, 6 patients (5 female, 1 male) underwent percutaneous cystolithopaxy of large volume calculi in lower urinary tract reconstructions. Continent catheterizable urinary diversions were present in all cases, constructed with ileum (3), ileum-sigmoid colon (1), colon (1), and unknown (1). The primary congenital anomalies included: spina bifida (1), female epispadias (1), classic bladder exstrophy (2), and cloacal exstrophy (2). The mean age at surgery was 26 years (range 11-45 years). The mean stone size was 26.6mm (range 15-40mm). In all cases, percutaneous access to the bladder was achieved pre-operatively with CT-guidance. In the operating room, a balloon dilator was used to place a 30 French working sheath, and cystolithopaxy was performed with an offset nephroscope and ultrasonic, laser, or ballistic lithotripsy. RESULTS CT-guided percutaneous access was achieved without complication in all cases. Mean operative time was 138.5 minutes. There were no intraoperative or postoperative complications including no bladder perforation, bowel injury, loss of continence, urinary tract infection/sepsis, or persistent urine leak. All patients were rendered stone-free. Mean length of hospitalization was 1 day. CONCLUSIONS CT-guided percutaneous access for percutaneous cystolithopaxy is a safe and effective technique in patients with congenital anomalies of the lower urinary tract. As children with such conditions grow older, previously known ‘safe areas' landmarked on the abdominal wall may become less reliable for percutaneous access and may risk injury to adjacent structures. Axial imaging can define a safe pathway from the skin to the stone, an important consideration in this challenging group of patients. Baltimore, MD© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e408 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anthony J. Schaeffer More articles by this author John P. Gearhart More articles by this author Brian R. Matlaga More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...