Transurethral Cystolithotripsy Research Articles

Comparison of three different modalities for the treatment of bladder calculi by size.

Treatment recommendations for kidney or ureteral stones are based on stone size; however, this is uncertain for bladder stones. This study aims to determine the best approach to bladder stones based on their size. We retrospectively analyzed 401 patients with bladder stones. Patients were divided into three different groups according to stone size (11-20 mm, 21-30 mm, 31-40 mm as groups 1, 2, and 3 respectively). Patients had transurethral cystolithotripsy (TUCL), percutaneous cystolithotripsy (PCCL), and open cystolithotomy (OCL) performed. Stone fragments were removed completely in all patients. When catheter time, postoperative stay, and hematocrit decrease values were compared, the results were significantly higher for OCL in all three groups (p: 0.001). When the relationship between stone sizes and operation time is evaluated, TUCL had shorter operation times (34.1 ± 10.6 min) in group 1. However, TUCL had longer operation times in group 2 and group 3 compared to OCL and PCCL. TUCL may be preferable due to better postoperative outcomes and shorter operative time for ⩽2 cm stones. As the stone size increases, PCCL is more favorable in terms of operation time.

Simple Solution to a Difficult Problem: Removal of Large Bladder Calculi Using a Laparoscopic Entrapment Sac

Introduction and Objectives: Percutaneous management of large bladder calculi with the use of a laparoscopic entrapment sac is a minimally invasive procedure that may have advantages over open cystolithotomy and transurethral cystolithotripsy, as well as standard percutaneous cystolithotomy. We first performed this procedure in 2008, and refined it after our initial publication in 2013 by changing the position from lithotomy to supine by using a urethral catheter postoperatively instead of a suprapubic (SP) catheter, by using ultrasound guidance for access, and by changing the procedure from being inpatient to outpatient. Our objective is to assess the continued feasibility of percutaneous entrapment sac cystolithotomy (PESC) and describe modifications that simplify the technique (mPESC), comparing outcomes and complications. Methods: Forty seven male patients underwent PESC from 2008 to 2019, 16 who had PESC and 31 who had mPESC. After extraction of calculi, either an SP catheter was placed, or the wound was closed and a urethral catheter was placed. Operative and follow-up parameters were compared between the two cohorts. Results: All patients were rendered stone free. Procedure time and length of stay were both significantly shorter in the mPESC cohort. Stone burden and estimated blood loss were equivalent between cohorts. There were no complications of urethral trauma in either cohort. The PESC cohort had higher rates of leakage from the SP site (25% vs 0%), increased need for catheter over 5 days (18.8% vs 0%), and greater likelihood of recurrent retention (12.5% vs 6%). Conclusions: Modifications of PESC, mPESC, leads to fewer complications and reduced length of stay compared with the original PESC procedure. This safe and efficacious technique can reduce morbidity during the management of large bladder calculi and is well suited for an outpatient procedure.

Simultaneous transurethral resection of the prostate and cystolithotripsy: A urological dilemma examined.

Controversy exists over whether transurethral resection of the prostate (TURP) in men with bladder stones prevents recurrence of stone formation and facilitates stone discharge. We sought to evaluate whether TURP in patients who underwent cystolithotripsy led to a lower recurrence of bladder stones for which a re-cystolithotripsy was necessary. Patients (n=127) who underwent transurethral cystolithotripsy with (n=38) or without simultaneous TURP (n=89) between January 2009 and December 2013 were retrospectively included in five centers in the Netherlands. Median followup was 48 months. The primary endpoint was to compare the relative risk between both groups for re-cystolithotripsy due to recurrent bladder stones. Secondary outcomes were the relative risk of urinary retention, the need for a (re-)TURP and the average time until recurrence. Patients who underwent a cystolithotripsy with a simultaneous TURP had a lower need for re-cystolithotripsy, resulting in a risk reduction of 72%. (relative risk [RR] 0.28 [0.07-1.13], p=0.06, number needed to treat [NNT]=7). The length of in hospital stay (3.4 vs. 1.6 days, p=0.04) and operative time (58 vs. 33 minutes, p<0.01) was longer when a TURP was performed. There was no significant difference in complication rate, occurrence of urinary retention, re-TURP, and re-admission. Eighty-one percent of patients who did not undergo a TURP remained free of bladder stone recurrence. Due to the retrospective nature of the study, essential data concerning prostate volume and micturition analysis was lacking. A simultaneous TURP in patients who underwent a cystolithotripsy showed a trend towards a protective effect on the need for re-cystolithotripsy.

Comparative Evaluation of the Results of Contact Pneumatic Cystolithotripsy and Electrohydraulic Cystolithotripsy

The objective: to evaluate the performance of portable pneumatic contact lithotripter LMA Stonebreaker (USA) for cystolithotripsy as compared to electrohydraulic cystolithotripsy (Urat-1M).Materials and methods. Contact cystolithotripsy was performed on 63 patients (49 men, 14 women). 27 patients underwent contact pneumatic cystolithotripsy, 36 patients underwent electrohydraulic cystolithotripsy. The effectiveness of the applied methods was evaluated in groups of patients not only by the size of the stones, but also by the mineral composition of the removed stone fragments (uric acid, phosphates, oxalates, ammonium urate). The number of strokes required to initiate fragmentation, complete fragmentation, and total cystolithotripsy time was determined.Results. The stones were fragmented in all 63 (100%) patients, regardless of the method of cystolithotripsy, mineral composition and size, and the stone fragments were completely removed and diagnosed by X-ray structural analysis. The lowest number of strokes to start the fragmentation process was in patients whose stones were diagnosed as ammonium urate and phosphates. Oxalate and uric acid stones required the greatest number of strokes. The number of strokes for complete disintegration of the stone, regardless of the method of cystolithotripsy, depends on the size of the stone, their number, and also the stone’s mineral composition. Conclusion: Transurethral contact pneumatic cystolithotripsy using a portable pneumatic lithotripter LMA Stonebreaker is not inferior to electrohydraulic cystolithotripsy (Urat-1M), however it is safer, taking into account the applied physical effects for stone destruction. It is also less costly.Conclusion. Effectiveness of applying both pneumatic and electrohydraulic cystolithotripsy depends not only on size and quantity of the stones, but also on their mineral composition. There are peculiarities in the process of cystolithotripsy of stones of different mineral composition.

Mini-percutaneous cystolithotripsy (mPCCL) versus transurethral cystolithotripsy (TUC) in pre-school children: Prospective comparative non-randomized outcomes over 8 years

Bladder stones in children can often be challenging to manage. We present our experience of minimally invasive percutaneous cystolithotripsy using 'mini-perc' instruments in the treatment of the bladder stones in pre-school children. The study also compares the outcomes of mini-percutaneous cystolithotripsy (mPCCL) and transurethral cystolithotripsy (TUC). We hypothesized that mPCCL is a new minimally invasive technique with comparable outcomes to TUC. After parental consent and institutional review board approval, consecutive pre-school children with bladder stones were included from January 2011-December 2018. We shifted from the TUC to mPCCL in 2014, with mPCCL introduced as a new technique. Outcomes including stone free rate (SFR) and complication rates were compared for patients aged between 1 and 5 years of age who underwent mPCCL or TUC. A total of 31 patients (16 patients in Group 1 (mPCCL) and 15 patients in Group 2 (TUC) underwent the procedure. The mean age, stone size and operative times were 2.4±0.96 years and 3.8±0.77 years; 1.86±0.65cm and 1.34±0.52cm; and 33.5±8.42min and 38.2±6.76min for groups 1 and 2 respectively. While there were no intra or post-operative complications in group 1, in group 2 one patient required conversion to mPCCL due to difficulty in fragment removal per urethra and one with residual fragment needed repeat cystoscopy and fragment removal (Clavien IIIb). All patients in both groups were discharged the following day after catheter removal and remained stone free at 1- and 6-month follow-up. Our study shows good outcomes in managing bladder stones with the use of both TUC and mPCCL. We shifted from the former to mPCCL in 2014 during which there was an overlap of both these techniques, while mPCCL was being introduced. Subsequently, all stones have been managed with mPCCL without the need to revert back to TUC. In Group 1, we performed mPCCL, where the puncture was performed under ultrasound-guidance and fragment retrieval was accomplished with the vacuum-cleaner effect through the operating sheath. Complete stone clearance was achieved in all cases with no complications or need for secondary procedures. Limitations of our study include small sample size, single-centre experience, and lack of randomization. Further prospective randomized multicenter studies may be required to validate our results. The technique of percutaneous suprapubic cystolithotripsy using mini-nephroscope is an alternate to transurethral cystolithotripsy. While both these techniques are suitable for smaller bladder stones, PCCL may be considered as the preferred management option of especially large bladder calculus in preschool children.

A consecutive series of patients undergoing trans-urethral cystolithotripsy with ballistic lithotripsy by a tertiary referral center for neurogenic bladder.

Background and aim of the work:Patients with neurogenic bladder (NB) have an increased risk of developing bladder stones due to bladder catheter, incomplete bladder emptying, recurrent urinary tract infections, and immobilization. In these patients, minimally invasive treatments are usually adopted, as noninvasive extracorporeal shockwave lithotripsy is limited by the risk of not clearing all stone fragments, and open surgery is usually discouraged. The aim of our study was to present our experience with trans-urethral cystolithotripsy (TUCL) in patients treated by a tertiary referral center for NB.Methods:We retrospectively collected pre-, intra- and post-operative data from our patients, who underwent TUCL from October 2013 to October 2019. The procedure was performed with a 24 Fr cystoscope and a ballistic lithotripter. Lapaxy was performed with Ellik bladder evacuator. All procedures were performed by two expert surgeons. Stone-free rate (SFR) was defined as the percentage of patients with absence of residual fragments >2 mm in diameter.Results:We performed consecutively 91 TUCLs in 75 patients during the selected period. SFR was 94.1%. Intra- and post-operative complications occurred in one (1.1%) patient. Our statistical analysis outlined the SFR was affected in a statistically significant way by sex, NB etiology, stone cumulative diameter, and operative time.Conclusion:Our series proved the safety and efficacy of TUCL with ballistic lithotripsy in NB patients. Further multicenter randomized controlled trials are mandatory to validate definitively TUCL as the gold standard therapy for bladder urolithiasis in NB patients, and to identify risk factors limiting the SFR. (www.actabiomedica.it)

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

Introduction: The retrograde approach is a modification that makes the percutaneous cystolitholapaxy (PCCL) a more trendy method, especially in operating rooms with limited facilities. The transurethral approach for bladder calculi lithotripsy by a laser has become popular among urologists. In this study, we investigate the feasibility and safety of retrograde assisted access for PCCL in comparison with transurethral cystolithotripsy by the holmium-YAG laser (Ho: YAG). Methods: According to the type of intervention, the patients were stratified to two matched groups. In the retrograde-assisted percutaneous cystolitholapaxy (RPCCL) group, a Benique was conducted through the urethra into the bladder; palpating the suprapubic region, an about 1.5 cm incision was done over the tip, then an Amplatz sheath was placed over it, treading into the bladder; further cystolitholapaxy was done by a routine order. In transurethral Ho: YAG laser lithotripsy (TULL) via 200 µm fiber vaporize the stone. Results: A total of 124 male patients with the mean age of 50.33±9.64 years and the average stone burden of 3.35±1.07 cm were included in the study. The most common cause of vesical calculi was spinal cord injury. Statistically significant differences were found in terms of the mean operation time in favor of the RPCCL group (P≤0.05) and the mean hospital stay in favor of the TULL group (P≤0.05). The stone-free rate (SFR) was 100% in both methods after a onemonth follow-up. None of the interventions changed to open surgery. There were not any major complications in both methods. Conclusion: RPCCL is a safe and effective method in bladder stone treatment and is applicable in medical centres without Ho: YAG equipment.

P169 - Trans-urethral cystolithotripsy in patients with neurogenic bladder: A consecutive series by a tertiary referral center

P169 - Trans-urethral cystolithotripsy in patients with neurogenic bladder: A consecutive series by a tertiary referral center

Cystolithotripsy: Effect of Nursing Preparations on Patients' Pain and Satisfaction

Transurethral cystolithotripsy is the most common way to manage cystolithiasis. Aim of this study: Was to evaluate the effect of implementing nursing preparations on improving patients' pain and satisfaction. Patients and methods Randomized Control Study design saw utilized to conduct this study. This study was carried out in the Urology and Nephrology Assiut University Hospital. A random sample of 60 adult patients of both sexes, the mean age of study group (51.20±11.73) and the mean age of control group (49.36±12.49). Patients were divided into two equal groups (study and control) 30 patients for each. Tools: Tool (I): Patient assessment sheet, tool (II): Pain numeric rating scale and tool (III): patient satisfaction with nursing care quality questionnaire. Results: Statistically significant differences were found between study and control groups post implementing nursing preparations as regard pain level and patients satisfaction. Conclusion: Significant pain improvement and high level of satisfaction were observed throughout implementation of the nursing preparations among the study group.

Comparative study of percutaneous cystoLithotripsy versus transurethral cystolithotripsy in children with bladder stones

Objective To evaluate the efficacy of percutaneous cystolithotripsy(PCCL) versus transurethral cyslithotripsy (TUCL) in children with bladder stones. Methods The clinical data of 16 children with bladder calculus treated with PCCL and 21 children with bladder calculus treated with TUCL in our hospital and people's hospital of Aketao county from January 2015 to May 2017 were analyzed retrospectively.and efficacies of these two different modalities were compared. Results The clearance rate of PCCL was 100 %, and no serious complications were found. One patient had residual stone after first TUCL, needed secondary TUCL, clearance rate was 95 %, and postoperative dysuria, odynuria occurred. There was no significant difference in age, operation time, complications and hospitalization days between the two groups. Conclusions Both PCCL and TUCL for bladder stones in children have good efficacy with high clearance rate and less complications. The choice of surgical methods should be based on the size of the stone, combined with the specific conditions of the patient, surgeon's skills and the hospital equipments, to develop individualized treatment program. Key words: Urinary Bladder Calculi; Lithotripsy

GIANT BLADDER CALCULI TREATED WITH SINGLE-STAGE SIMULTANEOUS PERCUTANEOUS SUPRAPUBIC AND TRANSURETHRAL CYSTOLITHOTRIPSY: A CASE REPORT

An 82-year-old man presented with lower abdominal pain and general malaise. Noncontrast computed tomography revealed a remarkably enlarged prostate and a full bladder with a giant stone 80 mm in diameter causing bilateral hydroureteronephrosis. Laboratory data demonstrated systemic inflammation and renal dysfunction with hyperkalemia. Acute postrenal dysfunction caused by urinary retention was diagnosed. A urethral catheter was inserted and emergent dialysis was initiated. After renal function recovered, we performed lithotripsy for the urinary bladder calculi. To achieve stone free status with a single-stage procedure, we performed simultaneous percutaneous suprapubic and transurethral cystolithotripsy. The procedure was successfully performed without significant complications.The patient was discharged 9 days after surgery, although clean intermittent catheterization was required.Giant bladder calculi are often treated with cystolithotomy because transurethral cystolithotripsy requires time to remove all fragments. In this case, we achieved stone free status in acceptable operative time by performing simultaneous percutaneous suprapubic and transurethral cystolithotripsy. In conclusion, the endourological management is an effective treatment choice, even in a case with a giant bladder calculus.

Surgical Management of Vesical Stones in Children: A Comparison Between Open Cystolithotomy, Percutaneous Cystolithotomy and Transurethral Cystolithotripsy With Holmium-YAG Laser.

Introduction: Bladder stone is more common in developing countries and it is one of the rare diseases affecting children. In recent years, there is an increasing tendency in urologists to have minimal invasive approaches. The aim of this study was to compare the results of surgical bladder stone management in our single tertiary center. Methods: From 159 children younger than 18 years with vesical stones treated during January 2000 to January 2015 in Shohada-e-Tajrish hospital, Tehran, Iran, 146 subjects entered to the study. According to type of intervention, patients stratified to three groups. First group included 80 patients that open cystolithotomy (OCL) was done for them, second group was 39 patients who underwent percutaneous cystolithotomy (PCCL) and third group was 27 patients who treated by transurethral cystolithotripsy with holmium-YAG laser (TULL). Demographic data, hospital stay, operation time, and post operation complications were recorded and comparison were drawn between the three groups. Results: Mean age was 8.3±5.1 years (8.6±5.1, 6±4.2 years for boys and girls, respectively). Mean stone size (MSS) was 2.76±1.07 cm and no significant differences were found between the three groups but it was larger in OCL group. Mean operative time (MOT) was 29.15±7.12 minutes in separate; MOT in TULL was significantly higher than PCCL and OCL respectively (36.3±5.97, 30.54±5.27 and 26.06±6.32 minutes/P =0.000). Mean hospital stay (MHS) in OCL group was 3.55±1 days that was higher than PCCL and TULL groups significantly (P =0.000). Conclusion: Based on our study, holmium:YAG lithotripsy has a high success rate, and is a minimally invasive management, therefore it is a safe method for children bladder calculi treatment if proper equipment was available and done by expert hands.

Clinical study and management of vesical calculus

Background: Vesical calculus accounts for 5% urolithiasis and is the most common urolithiasis in pediatric age. Although incidence has drastically reduced of late, vesical calculi continue to occupy an important place in everyday urological practice. Hence a study was performed to evaluate the clinical presentation and management of vesical calculus.Methods: A prospective study was conducted in the Department of General Surgery in a tertiary center between December 2012 to May 2014.Results: A total of 42 patients with vesical calculi were studied. Males were more affected than females (6:1). Pain abdomen was the most common presentation (71%). Fifty-two percentage patients were using bore well water to drink. Ultrasonography was the most sensitive investigation. All the cases were treated by surgical modality. Fifty percentage cases were treated with transurethral cystolithotripsy using 80-watt holmium laser. Twenty-one percentage cases underwent Percutaneous cystolithotripsy and the remaining 12 (29%) underwent the open suprapubic cystolithotomy. No complication was noted following percutaneous cystolithotripsy. Most of the vesical calculi were of mixed variety with predominant composition being calcium phosphate, calcium oxalate, and uric acid.Conclusions: Vesical calculus most commonly affects children less than ten years. Most of them present with pain abdomen. Low socio-economic status is more affected. Drinking hard water carries a high risk of vesical calculus. Ultrasonography is the investigation of choice in vesical calculus as it is 100% sensitive.

Percutaneous Cystolithotripsy As A Reliable Modality To Treat Pediatric Vesiculolithiasis

Background: Primary vesical stones are common in children in underdeveloped and developing countries. The treatment options available for managing bladder calculi include transurethral cystolithotripsy, open cystolithotomy and shock wave lithotripsy (SWL). Although the majority of vesical calculi in adults can be treated by transurethral lithotripsy, this procedure is restricted in children due to the narrow caliber of the urethra. For this reason, percutaneous cystolithotripsy (PCCL) is a good choice as a safe and effective method for the treatment of bladder stones in children.Aim of the Study: The study was aimed to evaluate outcome of PCCL in pediatric population coming with vesiculolithiasis in our center.Materials and Methods: Pediatric age group patients diagnosed as vesical calculus were undertaken for PCCL. Ten patients who presented between November 2014 to December 2015, were included. The procedure was done under general anesthesia. After performing cystoscopy, suprapubic puncture was made and tract dilated up to 26 Fr. Nephroscope was used for visualization and pneumatic lithotripsy for fragmentation of the stone followed by removal of st nd all fragments. Perurethral and suprapubic catheters were placed at the end to be removed on 1 and 2 post operative day, respectively.Results: Median age of the patients was 5.5 (3-13) years. Majority were male patients from hilly region of western Nepal. Mean stone size was 15 mm. All patients were rendered stone free with average operative time of 32.2 minutes. Except one minor complication of mucosal injury patients were discharged after mean hospital stay of 3.9 days.Conclusion: Percutaneous suprapubic lithotripsy is a safe and effective method for the treatment of bladder stones in children. It is fast and associated with negligible complications.JNGMC Vol. 14 No. 1 July 2016, Page: 18-20

Outpatient Transurethral Cystolithotripsy of Large Bladder Stones by Holmium Laser.

To assessment of the efficacy and safety of transurethral cystolithotripsy of large bladder stones by holmium laser in the outpatient setting. In a prospective study, 48 consecutive adult patients with large bladder stones, were enrolled for transurethral cystolithotripsy. Patients older than 18 years, with bladder stones larger than 2 cm were enrolled. Urethral stricture, active urinary infection, and any anesthetic contraindications for operation, were the exclusion criteria. Demographic characteristics of patients, outcomes and complications related to operation and post operation period, were recorded. Patients mean age was 46 ± 7.3 years. Male to female ratio was 45/3. Mean body mass index of patients was 28.5 ± 3.5. Mean stone size was 3.7 ± 1.6 cm. Mean operation time was 43.5 ± 15.5 minutes. Nearly complete stone clearance (98.5%) was achieved in all patients. Mean hospital stay was 6.5 ± 1.3 hours. No major complications were seen. Mean visual analog pain score (VAS) was 4.2 ± 2.1 and 1.4 ± 0.6, during and 1 hour after operation, respectively. During follow up of 22.4 ± 12.5 months, recurrence of bladder stone was not seen. No case of urethral stricture was detected. Transurethral holmium laser lithotripsy is an effective and safe alternative in selected patients with large bladder stones. This procedure can be easily performed in the outpatient setting.

Transurethral Cystolithotripsy of Large Bladder Stones by Holmium Laser as a Day Care Procedure.

Bladder stones constitute around 5% of bladder stones in the developed countries. Holmium laser lithotripsy has revolutionised the treatment of urinary lithiasis. The aim of this study was to report the outcome of transurethral cystolithotripsy with Holmium Laser under Local Anaesthesia (LA) as a day care procedure in patients with bladder stones. Patients with bladder stone greater than 1.5cm attending urology Outpatient Department underwent transurethral cystolithotripsy with Holmium Laser under LA as day care procedure. The results were analysed on aspects of peri-operative pain, completion of procedure, stone clearance, hospital stay, complications and patient compliance. A total of 85 patients with bladder stone ≥1.5cm underwent transurethral cystolithotripsy LA. The mean age of the patient was 52±7 years. There were 80 males. The mean size of stone was 3±1.2cm. Mean operation time was 40±10 minutes. Complete stone clearance was achieved in all the patients. None of the patients required hospital stay following the procedure. Transurethral holmium laser lithotripsy is an effective and safe procedure for large bladder stones. This procedure can be easily performed as a day care procedure.

A Study of Management of Urinary Bladder Stone by Cystoscopic Transurethral Pneumatic Cystolithotripsy in Rural India

A Study of Management of Urinary Bladder Stone by Cystoscopic Transurethral Pneumatic Cystolithotripsy in Rural India

Transurethral cystolithotripsy in gas (CO2) medium

Transurethral cystolithotripsy in gas (CO2) medium

Comparison of Transurethral use of Nephroscope with Cystoscope in Transurethral Cystolithotripsy

Comparison of Transurethral use of Nephroscope with Cystoscope in Transurethral Cystolithotripsy

Minimally Invasive Surgery for Patients with Bulky Bladder Stones and Large Benign Prostatic Hyperplasia Simultaneously: A Novel Design

Objective: To determine the efficacy and safety of a novel minimally invasive design for treating bulky vesical calculi and large benign prostatic hyperplasia (BPH) simultaneously. Methods: 76 patients with large bladder stones (>4 cm) and large BPH (≥50 cm³) were treated from August 2008 to January 2011. 38 patients (group 1) underwent transurethral cystolithotripsy followed by transurethral resection of the prostate (TURP), 38 patients (group 2) received percutaneous cystolithotripsy within a laparoscopic entrapment bag and TURP by two surgeons simultaneously. 72 patients were followed up for 1 year. Patient demographics, perioperative parameters and follow-up data were compared. Results: Patient baseline characteristics were comparable in the two groups. In group 1, 3 patients converted to open surgery and received blood transfusion, 4 patients had postoperative fever, 2 had residual stones and 1 developed urethral stricture postoperatively. In group 2, the mean total operative and the operative times for stone management were 71.6 and 30.1 min, respectively, the mean hemoglobin decrease was 0.80 g/dl, no patients received blood transfusion and no complications occurred, significantly superior to group 1. Conclusions: Percutaneous cystolithotripsy using a laparoscopic entrapment bag associated with TURP by two surgeons simultaneously is a highly effective, safe and minimally invasive method for managing large vesical calculi and large BPH.