Single percutaneous access for endoscopic extraction of lithiasis after intestinocystoplasty

Abstract

Purpose Bladder-stone formation is a common problem following augmentation cystoplasty. Urological management is controversial. We describe a minimally invasive technique using electrohydraulic vesicolithotripsy via a single percutaneous access. Material and methods Between 1998 and 2004, 10 percutaneous extractions of bladder calculi were performed in seven patients with bladder augmentation. Prior bladder enlargement was performed for neuropathic bladder dysfunction in four cases and bladder exstrophy in three cases. The procedure involved percutaneous placement of a 10- or 12-mm laparoscopic trocar, after which the airtightness valve of the trocar was removed. A rigid nephroscope allowed direct visualization of calculi. Stones were fragmented with electrohydraulic lithotripsy when necessary. Removal of the fragments was by grasping forceps or basket. Vigorous, warmed-saline bladder irrigation eliminated residual fragments. Results The technique was successful in all cases, resulting in controlled bladder-stone-free status and no surgical complications. The only complication was hypothermia linked to prolonged operation time, inadequate warmed-saline irrigation and lack of waterproof sheets. Conclusions Percutaneous vesicolithotripsy was highly successful and easy to perform, without being restricted by size and number of calculi. The continence mechanism of a reconstructed urethra or Mitrofanoff conduit should not be compromised. As recurrent stone formation is expected in children with augmented bladder, this technique appears to be suitable for bladder calculi removal during the long-term follow-up of multioperated patients.