Treatment Of Bladder Stones Research Articles

14F Super-Mini Percutaneous Cystolitholapaxy: A Novel Technique in the Treatment of Bladder Stones.

Introduction: This single-center experience describes the indications, novel technique, and outcomes of performing 14F super-mini percutaneous cystolitholapaxy (14F-SMPCCL). Materials and Methods: Cases between 2019 and 2022 were retrospectively identified with surgical outcomes recorded. Using percutaneous access to the bladder, an endoscope was inserted through the ClearPetra 14F super-mini sheath and laser lithotripsy completed with stone fragments suctioned out. Results: Sixteen cases were included in the study and all patients were adults. Average conglomerate stone size was 28.1 mm (range = 10-50 mm). Average operative time was 60.0 minutes (range = 23-110 minutes). Visual stone-free rate was 91.7%, radiologic stone-free rate was 81.3%, and average postoperative length of stay was 1 day. One patient developed urosepsis postoperatively and there were no other complications. Conclusion: The novel technique of 14F-SMPCCL is safe and feasible for treating large burdens of bladder stones with a conglomerate size of ∼2.5 to 5 cm. Active suction allows for efficient removal of stone fragments.

The Effectiveness and Safety of Percutaneous Cystolithotripsy for Vesicle Calculus in Children: A Single-Center Study

Background: Primary bladder stones are common among children from developing countries but may be difficult to cure. Transurethral cystolithotripsy, open cystolithotomy, and shock wave lithotripsy are the treatment modalities for vesical calculi in children. Transurethral lithotripsy is less efficient in children because of the small caliber of the urethra. PCCL is a less intrusive and efficient procedure for removing bladder stones in pediatric patients. Objectives: The objective of the study was to determine the safety and efficacy of PCCL in children with bladder stones in third-world nations. Materials and Methods: There was a search for( PCCL) in pediatric individuals diagnosed with vesical calculus. 90% male and 10% female total of 120 patients enrolled in the single-center trial at the Department of Pediatric Urology at the Institute of Kidney Diseases between January 2021 to January 2022. The surgery was performed under a general anesthetic. After a thorough inspection, a suprapubic puncture of the lower urinary tract (by cystoscopy) was done. The tract was only dilated up to 14 Fr. The stone was fragmented using pneumatic lithotripsy after passing the nephroscope. After 36 hours per urethral catheter was removed. Results: In this study, the mean age of the patients was 4.2.14 years. The majority of patients were kids. The average gem was 9.3 millimeters in diameter. Successful stone fragmentation and retrieval took place in an average of 40 min. The only major problems seen during or after surgery were hematuria, infection, and moderate mucosal injury; all three were managed conservatively. In 108 out of 120 cases (90%), ammonium acid urate was found to be the primary constituent of the stones and the core. Conclusion: The success rate of percutaneous cystolithotripsy in the treatment of bladder stones in children is higher, and it is ready for immediate use. The operation is quick and causes minimal discomfort. Keywords: Effectiveness, Percutaneous , Cystolithotripsy, Vesical Calculus, Children

Comparison of nephroscopy and cystoscopy used in the treatment of bladder stones: a systematic review and meta-analysis of randomized controlled trials

BackgroundA systematic review and meta-analysis was conducted to compare the safety and efficiency of nephroscopy and cystoscopy in transurethral cystolithotripsy (TUCL) for bladder stones (BS).MethodsThe PubMed, Web of Science, Embase, EBSCO, and Cochrane Library databases were searched up to January 2021 for studies assessing the effect of different types of endoscopes among patients who underwent TUCL. The search strategy and study selection process were in accordance with the PRISMA statement.Results Five randomized controlled trials were included in the meta-analysis. The results showed no difference in stone-free rate (RR = 1.00, CI = 0.98–1.02, p = 1.00) between the two groups and nonsignificant heterogeneity (I2 = 0%, p = 1.00), and all patients were rendered stone free. Use of the nephroscope significantly shortened the operative time compared with the cystoscope group (RR= − 26.26, CI = − 35.84 to − 16.68, p < 0.00001), and there was significant heterogeneity (I2= 87%, p < 0.00001). There was no significant difference in mean urethral entries (RR = 0.66, CI = − 0.71 to − 2.04, p = 0.35), hospitalization (MD = 0.08, 95% CI = − 0.07 to 0.23, p = 0.31) or total complication rate (RR=1.37, 95% CI = 0.47–4.00, p = 0.56) between the two groups.ConclusionsIn conclusion, this systematic review demonstrates that both nephroscopy and cystoscopy have high stone clearance efficiency, low rates of complications and short hospitalizations. The mean urethral entries depend on the treatment method for large stone fragments. However, the use of nephroscopy can significantly reduce the operative time.

Which Endoscopic Methods in Prepubertal Patients with 10-20 mm Bladder Stones: Transurethral Cystolithotripsy or Percutaneous Cystolithotripsy?

Background: The aim of this study was to evaluate the efficacy and safety of transurethral cystolithotripsy (TUC) and percutaneous cystolithotripsy (PCC) in prepubertal patients with 10-20 mm bladder stones. Materials and Methods: The files of patients aged 12 years and under who were admitted to our clinic for bladder stones from January 2007 to January 2021 were reviewed retrospectively. Inclusion criteria were patients who were 12 years of age and under with 10-20 mm bladder stones, and who underwent endoscopic surgery (TUC or PCC). None of the patients had prior bladder or stone surgery. The patients were divided into two groups (Group 1: PCC group, and Group 2: TUC group) and collected data (preoperative, intraoperative, and postoperative characteristics) were compared between the groups. Results: This study was enrolled 51 patients (21 patients in Group 1 and 30 patients in Group 2). The mean ages of the groups were similar (Group 1: 4.7 ± 3.6; Group 2: 4.6 ± 3.2; p = 0.936). The mean stone size was 15.8 ± 3.5 in Group 1, and 12.1 ± 2.4 mm in Group 2. It was higher in the PCC group than TUC group (p < 0.001). The operative time was lower in Group 1 than Group 2 (36.4 ± 12.9 vs 42.7 ± 16.3 minutes, respectively), but there was no statistically significant difference between the groups (p = 0.117). We achieved stone-free rate (SFR) for all the patients in both groups. Complications were observed in 4 (7.7%) cases. One female patient was in Group 1 and three male patients were in Group 2. There was no difference for complication rates between the groups (p = 0.634). Conclusions: Endoscopic surgeries have almost become a routine method in the treatment of bladder stones. Despite larger stone size, PCC provides similar SFR compared with TUC along with a tendency of shorter operative time. However, the use of the TUC method in male toddlers could increase the risk of postoperative urinary retention. Hence, stone size and patient age should be considered in the selection of a surgical approach.

Our experience of laser lithotripsy under local anesthesia in the treatment of bladder stones in obese male patients

Introduction: Our century has witnessed a significant increase in obesity, which in its turn, bears several major risks in management of systemic anesthesia. In this context, use of this treatment without general or regional anesthesia is of critical importance for patients under this group. &#x0D; Aim: In present study, it was aimed to analyze the efficacy and safety of holmium laser lithotripsy (HLL) under local anesthesia in obese male patients with bladder stones.&#x0D; Material and Method: In our study, we evaluated a total of 64 obese male patients with body mass index (BMI) ≥ 30 kg/m2, diagnosed with bladder stones and treated HLL under local anesthesia. Demographic data, stone size, operative time, urethral catheterization time and length of hospital stay of the patients were analyzed. Visual Analogue Scale (VAS) scores was calculated for each patient during the procedure. Complications were graded according to modified Clavien classification system.&#x0D; Results: The mean age of patients was 50.58 ± 13.04 years and BMI was 33.46 ± 2.59 kg/m2. Mean stone size was 2.51 ± 1.04 cm and operative time was 43.91 ± 15.92 minutes. None of the patients had severe pain and the mean VAS score was calculated as 2.31 ± 1.02. Mean length of hospital stay was 1.25 ± 1.04 days. Grade 3 or higher complications were not observed according to modified Clavien classification system. Mean urethral catheterization time was 1.56 ± 1.45 days, although varying due to underlying etiological factor. All patients were stone-free and there was a marked improvement in clinical findings.&#x0D; Conclusion: Use of HLL under local anesthesia is a safe and efficacious approach in obese male patients with bladder stone.

Transurethral fragmentation of bladder stone in children: Our experience

Background: This study is performed to find the outcome of transurethral fragmentation and clearance of bladder stones in children as well as assessment of stone recurrence after the procedure. Methods: It was a retrospective analysis of the medical record of 365 patients with bladder stones, treated with transurethral fragmentation at the Department of Pediatric Urology, The Children’s Hospital and the Institute of Child Health, Lahore, over a period of 5 years. Bladder stones were fragmented by using ureterorenoscope (URS) and pneumatic Lithotripsy under general anesthesia. Patients were asked to void next day for spontaneous passage of stone fragments. Duration of procedure, hospital stay, peroperative, and postoperative complications were recorded on a self-structured proforma. The collected data was analyzed with SPSS, version 22. Results: The mean age of the patients was 4.7 ±2.31 years, and male to female ratio was 6:1. Clinical presentation was painful micturition with milking of penis (55%), followed by straining during micturition (17.5%), urinary retention (10%), increased frequency of urine (8%), febrile UTI (7.5%), and hematuria (2%). The mean stone size on ultrasound was 17.2 ±3.8 mm (Range 7-25 mm). The average operating time was 18 minutes (Range: 12-35 minutes). The transurethral fragmentation was successfully done in all (100%) patients. Average hospital stay was 24 hours. Most patients (98.5%) passed all stone fragments in urine &amp; were stone free at one week, confirmed by ultrasound and X-Ray Kidney, Ureter, and Bladder (KUB). Postoperative minor complications were found in (6%) patients including hematuria (3%), dysuria (2%), febrile UTI (1%), failure to void (0.5%). Stone recurrence was 0.27% and no urethral stricture was noted up to one year follow up. Conclusion: Endoscopic treatment of bladder stone in children appears effective and safe by fragmenting the stone into multiple small pieces, which passed out spontaneously without any need for extraction of stone. The associated complications and recurrence rate are very negligible.

Medicinal Chemistry of Alternative Therapeutics: Novelty and Hopes with Genus Ammannia.

The plants have formed the basis of folklore remedy since the beginning of human civilization. The cumulative human endeavor and experience over a period of thousands of years developed into well to organize traditional medicine systems viz. Ayurvedic, Unani, Chinese amongst others. Across the world, traditional medicine is either the mainstay of health care or serves as a complement to modern drugs. In view of worldwide use of traditional medicines, World Health Organization launched 'WHO-Traditional Medicine Strategy 2014-2023' for the development of strong policies regarding knowledge-base, safety, quality-control and effectiveness of traditional/alternative therapeutics for national health systems. Besides their use in traditional medicine, plants have always been a good source of modern drug/pharmacologically active molecules. More than half of the modern pharmaceuticals are either plant isolates or their derivatives. The plant-based drugs are not only effective, but have better compatibility with human biological systems because of more biologically relevant chemistry, hence lesser side effects. Some of the species of genus Ammannia (Lythraceae) have been reported for their magical medicinal values. Many herbal formulations containing Ammannia spp. have been patented for treatment of serious diseases/disorders like cancer, spinal disease, human female infertility, chronic tonsillitis, pelvic inflammatory disease, treatment of bladder stones, urinary tract infections, dermatitis etc. The uses of Ammannia spp. in traditional medicine have been further verified by the biological activities of their extracts as well as isolation of bioactive phytomolecules. The current review provides details about Ammannia spp.; its use in folklore remedy, herbal formulations, biological activities of extracts, isolation of bioactive phytomolecules and SAR study of semi-synthetic derivatives to analyze the possibility of new drug molecules of plant origin.

PT349 - Treatment of bladder stones in adults: A systematic review and meta-analysis on behalf of the EAU Urolithiasis Guideline panel

PT349 - Treatment of bladder stones in adults: A systematic review and meta-analysis on behalf of the EAU Urolithiasis Guideline panel

443 - Treatment of bladder stones in children: A systematic review on behalf of the EAU Urolithiasis Guideline Panel

443 - Treatment of bladder stones in children: A systematic review on behalf of the EAU Urolithiasis Guideline Panel

Comparative study of laparoscopic cystolithotomy and electro-resectoscopic holmium laser lithotripsy for the treatment of bladder stone

Objective To compare the clinical efficacy of laparoscopic cystolithotomy and electro-resectoscopic holmium laser lithotripsy for the treatment of bladder stone. Methods Sixty-one cases with complicated bladder stones in our hospital from January 2014 to March 2017 were chosen.And all patients were randomly divided into the study group (29 cases)and the control group (32 cases). The study group was treated with laparoscopic cystolithotomy, while the control group was treated with electro-resectoscopic holmium laser lithotripsy.The operation time, the time of indwelling catheter, the rate of stone clearance and postoperative complications rate were compared between the two groups. Results There was no significant difference between the two groups in the time of indwelling catheter and hospitalization(P>0.05). The operation time of the study group was shorter than that of the control group(P<0.05). The rate of stone clearance of the study group was higher than that of the control group(P<0.05). The incidence of urinary tract infection, urethral stricture and other complications in the study group were lower than those in the control group(P<0.05). Conclusions The laparoscopic cystolithotomy has many advantages, such as short operation time, less complications, higher stone clearance rate, and so on. It is worthy of clinical application. Key words: Urinary Bladder Calculi; Lithotripsy, Laser; Lasers, Solid-State; Holmium; Laparoscopy; Electrosurgery

V410 TIPS FOR PRESERVING PUDENDAL NERVE INNERVATION TO THE MALE URINARY SPHINCTER DURING PELVIC SURGERY

INTRODUCTION AND OBJECTIVES: Compared to endoscopic transurethral resection of prostate open prostatectomy allows for more complete removal and lower retreatment rates. Proposed disadvantages of the open approach include the need for an abdominal incision, longer hospitalization and recovery. Post-operative hemorrhage is also more likely vs. the endoscopic approach. We believe that mimicking the open suprapubic prostatectomy with minimally invasive robotic technology afford the surgeon the advantages of open prostatectomy without the potential disadvantages. As the first step in testing this notion, we present our surgical technique suprapubic prostatectomy, an intravesical approach. METHODS: Using the daVinci Si robot, with port placement similar to a robotic radical prostatectomy, a suprapubic prostatectomy in preformed and described. The steps needed to achieve enunciation of prostatic adenoma are systematically presented. We present potential advantages of the intravesical approach and results of this case. RESULTS: The critical steps of the robotic suprapubic prostatectomy are illustrated and described in our video. The surgeon first drops that bladder from the anterior abdominal wall. The bladder neck is then opened in a horizontal fashion. The bladder mucosa is circumscribed at the bladder neck, allowing for the development of a plain between the adenoma, bladder mucosa and prostatic capsule. This is aided by the use of the robotic tenaculum. The enuclation is carried out from the bladder neck to the apex. The prostatic adenoma is removed with little blood loss and excellent visualization though out. Two figureof-eight sutures are placed achieving excellent hemostatis. A running v-lock suture is used to recreate the trigone. The bladder is then closed using another v-lock suture. The intravesicle approach allows for simultaneous treatment of bladder stones, bladder diverticulum and large intravesicle median lobes. The patient shown is the video was successfully treated using this technique with resolution of his urinary retention and improvement in his LUTS. CONCLUSIONS: This video presents our technique for managing benign prostatic hypertrophy causing lower urinary tract symptoms when traditionally an open approach would have been performed. In our early experience the steps of this technique mimics those of the open approach with improved visualization ease of reconstruction and quicker convalesce than an open approach. Now that we have described our technique we hope to prospectively compile complications data as well as objective and subjective outcomes measures to allow comparison to open approaches.

Ileal Conduit and Continent Ileocecal Pouch for Patients Undergoing Pelvic Exenteration: Comparison of Complications and Quality of Life

Objectives:Creating a continent urinary pouch has become an alternative to the ileal conduit for patients undergoing exenteration for advanced gynecologic malignancies. The objective of this study was to compare clinical outcomes for the 2 methods.Methods:In this retrospective study, we compared intraoperative and postoperative complications and quality-of-life scores for the modified ileocecal pouch and the ileal conduit in anterior or total pelvic exenteration.Results:In 33 of 100 patients, an ileal pouch (IP) was created; the other 67 were treated by an ileal conduit (IC). Creating an IP prolonged the exenterative procedure by 97 minutes compared to an IC (IC, 453 minutes vs IP, 550 minutes;P= 0.009). Overall complication rates were similar, but patients with an IP had significantly more complications of urinary diversion (48%) than patients with an IC (31%;P= 0.03). Follow-up showed urinary loss and frequency of micturition to be comparable, but in patients with an IP, surgery for stomal complications (n = 2) and treatment of bladderstones were necessary more frequently (n = 3). Quality of life according to the 12-item Short Form Health Survey questionnaire was similar in both groups.Conclusion:A continent IP is an alternative to the IC in cases of pelvic exenteration. Early complications are more frequent with an IP than with an IC. The mode of urinary diversion has little influence on the quality of life in patients with advanced genital cancer.

Feasibility and Outcome of Retrograde Endoscopy in A Post-Prostatectomy Population

To determine the feasibility of retrograde endoscopy after radical retropubic prostatectomy (RRP) and its effects on post-prostatectomy continence. We retrospectively reviewed all patients who underwent RRP at our institution between 1999 and 2005, identifying those who subsequently required endoscopic instrumentation. Patient records were examined for the interval between procedures, method of endoscopy, and continence after endoscopy compared with baseline post-prostatectomy continence. Twenty-one patients were identified who required endoscopic instrumentation from 4 to 49 months after RRP. Of these, 13 patients underwent ureteroscopy for stones (N = 8) or stricture disease (N = 5). In 3 cases, a ureteral access sheath was used, and in 12 cases, a ureteral stent placed postoperatively. Review of the operative reports revealed no complications or difficulty with cannulation of the ureteral orifice(s) or sheath placement. Eight patients underwent rigid cystoscopy for hematuria, removal of a foreign body, or treatment of bladder stones (N = 2 each) or for stent placement and frequency (N = 1 each). The ureter could not be identified in one case of attempted stent placement for hydronephrosis because of a distal-ureteral stone. A follow-up intravenous urogram confirmed passage of the stone and resolution of the hydronephrosis. There were no other reported difficulties with rigid cystoscopy. There was no documented change or adverse outcome regarding continence after endoscopy. Post-prostatectomy retrograde endoscopy is feasible for the management of common urologic pathologies. Endoscopic instrumentation across the urethrovesical anastomosis did not have an adverse effect on urinary continence.

Treatment of bladder stones without associated prostate surgery: Results of a prospective study

Objectives To assess the effectiveness of noninvasive bladder lithiasis treatment without associated prostate surgery to know whether bladder lithiasis is an absolute indication for prostate surgery. Methods Fifty patients with bladder lithiasis were entered in a prospective trial and were treated with extracorporeal shock wave lithotripsy if lithiasis was smaller than 4 cm 2. Independent of the presence or absence of bladder outlet obstruction, in no case was prostate surgery associated. The variables studied were the effectiveness of the treatment, changes in the International Prostate Symptom Score (IPSS), and the subsequent need for desobstructive prostate surgery. The statistical study was performed using Student’s t test and the proportional hazards model. Results Bladder lithiasis was successfully eliminated in 93% of the cases (in 77% of them with a single extracorporeal shock wave lithotripsy session). The mean IPSS decreased from 17.7 to 9.7 points ( P = 0.0001) after lithiasis elimination. After a mean follow-up of 22 months, a mere 8% of the patients needed subsequent prostate surgery because their IPSS had increased to 20 points or more. The sole prognostic factor for the need for ensuing prostate surgery was the pretreatment IPSS score ( P = 0.042). Conclusions Noninvasive management of bladder lithiasis with no associated prostate surgery is highly efficient and results in marked symptomatic improvement. Furthermore, the number of patients needing subsequent prostate surgery was very low at mid-term follow-up. Because of all of the above, the existence of bladder lithiasis is not an absolute indication for prostate surgery.

Commentary: Treatment of bladder stones and probabilistic reasoning in medicine: an 1835 account and its lessons for the present

Commentary: Treatment of bladder stones and probabilistic reasoning in medicine: an 1835 account and its lessons for the present