1707 URONET™: A NOVEL DEVICE FOR MANAGING PATIENTS WITH BLADDER AND RENAL STONES

Abstract

INTRODUCTION AND OBJECTIVES: For patients treated for large bladder and renal stones, open lithotomy, percutaneous approach and transurethral cystolithalapaxy have been the standard of care. Complete removal of these stones is paramount to eliminate stone burden and to help prevent stone recurrence. We describe our experience with a new device for evacuation of large bladder stones by percutaneous cystolithalapaxy and staghorn renal stone(s) removal by percutaneous nephrolithotomy (PCNL). METHODS: We treated 20 patients who presented with bladder stones (10) and/or renal stones (12). The mean stone burden was 6 cm and 3 cm for bladder and renal stones, respectively. The mean age of patients was 56 years with male predominance of 9:1 in the bladder stone group and parity of gender with 5:5 ratio for renal stones. Extraction of stones following cystoscopy/laser lithotripsy (7), percutaneous cystolithalapaxy (2) or stone manipulation (1) of bladder stones and percutaneous nephrolithotomy (12) for renal stones were performed with the UroNetTM (US Urology, Cleveland, Ohio). Stones were extracted using the 5.4F or 9.6F UroNetTM mesh (3.0cm x 1.25cm) device for percutaneous cystolithalapaxy or PCNL, respectively. RESULTS: The smaller UroNetTM device was ideal for removal of bladder stones and the larger device successfully removed stones within the kidney. The UroNetTM was ideal for removal of stones between 2-10mm in size and the softer, sludge-like stones. In one patient undergoing a PCNL procedure, extraction of 108 renal stones was completed with 25 passages of the UroNetTM. Smaller particles were extracted by aspiration techniques. All patients had successful treatment of stones without any complications. Stone composition included Calcium Oxalate (9), Calcium Phosphate (5), Struvite (2), Uric Acid Stones (3) and mixed type stones (3). CONCLUSIONS: The UroNetTM is a safe, reliable and efficient disposable device to remove multiple stone fragments with each passage of the device. The limited passage of instruments helps minimize trauma to the bladder, urethra and kidney during cystolithalapaxy and PCNL procedures. More efficient stone extraction also decreased operative and anesthesia times. Prospective studies are currently underway to compare classic stone baskets to the UroNetTM.