Minimally invasive percutaneous management of large bladder stones with a laparoscopic entrapment bag.
BACKGROUND
The treatment of large volume bladder stones is a management conundrum. Transurethral methods are plagued by long operative times, trauma to the bladder mucosa, and the need for a postoperative urethral catheter. Open cystolithotomy has higher morbidity. We present the percutaneous management of bladder stones with the novel use of a laparoscopic entrapment bag.


METHODS
Twenty-five patients (mean age 65.7), including 22 men and 3 women, 4 with a neurogenic bladder and 21 with a prior diagnosis of benign prostatic hyperplasia, underwent our novel technique. The mean number of stones was 6.8±8.0 (range, 1 to 30) and total stone burden 10.4±10.5 cm (range, 3.0 to 50.0 cm). Using regional or general anesthesia and flexible cystoscopic guidance, percutaneous bladder access was achieved. The tract was balloon dilated to 30F and stones captured in a laparoscopic entrapment bag. The bag's opening was exteriorized and stone fragmentation and comminution were achieved using a nephroscope and pneumatic or ultrasonic lithotripters. The bag was extracted and a 22F suprapubic catheter was inserted into the bladder; the patient was discharged the next day after a voiding trial. The procedure was done without fluoroscopy. No foley catheter was necessary.


RESULTS
All patients were rendered stone free. The mean estimated blood loss was 11.1±3.93 mL (range, 10 to 25 mL). The mean operative time was 102.3 minutes. There was minimal trauma to the bladder mucosa and no complications of fluid extravasation, hematuria, or urethral trauma were noted. All patients were discharged within 24 hours of the operation.


CONCLUSIONS
Percutaneous cystolithotomy with the use of an entrapment bag is an efficient, safe technique for treating large volume bladder calculi. We recommend this technique as an alternative to open surgery for patients with too large a stone burden to remove transurethrally.
Department of Urology, Columbia University , New York, New York.
Yung K
YK
Tan
Dilan M
DM
Gupta
Aaron
A
Weinberg
August J
AJ
Matteis
Sunny
S
Kotwal
Mantu
M
Gupta
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation; D003558:Cystoscopy; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D008096:Lithotripsy / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011470:Prostatic Hyperplasia / Q000601:surgery; D001744:Urinary Bladder Calculi / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery; D055815:Young Adult