title: Percutaneous suprapubic cystolithotripsy for treatment of large bladder calculi.
abstract: OBJECTIVE
  The treatment options available for managing bladder calculi include transurethral cystolithotripsy, open cystolithotomy, and shockwave lithotripsy. For larger calculi, transurethral treatment can be time consuming, and the manipulation has the potential to cause urethral injury. Percutaneous suprapubic cystolithotripsy represents another treatment option for bladder calculi which is effective and minimally invasive.
  
  
  METHODS
  Fifteen patients had bladder calculi treated with percutaneous cystolithotripsy over a 3-year period. The mean stone size was 39 mm (range 10-64 mm). Stones were single in seven patients and multiple in eight patients. The indications for cystolithotripsy were stone size >3 cm, multiple stones >1 cm, and inability to perform transurethral cystolithotripsy because of patient anatomy. Percutaneous suprapubic cystolithotripsy was done through either a 30F or a 36F cystotomy tract. Fragmentation and removal was performed with a 26F rigid nephroscope and the pneumatic Swiss Lithoclast. Suprapubic and urethral catheters were placed postoperatively in all patients.
  
  
  RESULTS
  Each patient was cleared of the stone burden with a single procedure, and there were no major complications. The mean duration of suprapubic catheterization was 2.6 (range 1-5) days.
  
  
  CONCLUSIONS
  Percutaneous suprapubic cystolithotripsy is an effective and safe technique for treating large bladder calculi. It is minimally invasive, avoids urethral injury, and, in combination with the pneumatic Swiss Lithoclast, can be used to fragment and remove large and hard bladder calculi.
authors.affiliation: Division of Urology, University of Western Ontario, London, Canada.
authors.forename: T A
authors.initials: TA
authors.lastname: Wollin
authors.forename: R K
authors.initials: RK
authors.lastname: Singal
authors.forename: T
authors.initials: T
authors.lastname: Whelan
authors.forename: R
authors.initials: R
authors.lastname: Dicecco
authors.forename: H A
authors.initials: HA
authors.lastname: Razvi
authors.forename: J D
authors.initials: JD
authors.lastname: Denstedt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019723:Endoscopes; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000295:instrumentation / Q000379:methods; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D010316:Particle Size; D013997:Time Factors; D016896:Treatment Outcome; D001744:Urinary Bladder Calculi / Q000628:therapy*