title: Transurethral Pneumatic Cystolithotripsy: A Novel Approach.
abstract: Various endoscopic instruments used in treating renal stones have been used in managing bladder calculi. Our aim is to evaluate the use of transurethral ureteroscopic pneumatic cystolithotripsy for the management of large bladder calculi.
  
  
  
  In a retrospective study conducted between May 2005 and July 2011, 53 patients with solitary bladder stones were subjected to our technique, transurethral ureteroscopic pneumatic cystolithotripsy. The mean patient age was 54.3 years. The mean stone size was 4.8 cm. Diagnostic cystoscopy was performed first. A semirigid ureteroscope with a pneumatic probe was introduced through the cystoscope sheath, and pneumatic lithotripsy was performed. The cystoscope sheath works as a draining channel, allowing bladder evacuation. The bladder collapses over the stone and, subsequently, prevents stone migration, which shortens the lithotripsy's duration. Stone immobilization allows the transmission of full pneumatic power to the stone. The stone fragments were removed through periodic bladder irrigation using an Ellick evacuation-irrigation system, and a 16F Foley catheter was placed at the end of the procedure.
  
  
  
  Our technique was effective in all cases, including stone-free bladders. No surgical complications were detected. The mean operative time was 83 ± 21.0 minutes, which is comparable to that of standard management. The mean duration of lithotripsy and evacuation was 29.7 ± 18.4 minutes. In the postoperative period, patients were followed up for 18 months, with no urethral stricture being reported in any case.
  
  
  
  The transurethral ureteroscopic pneumatic cystolithotripsy procedure is a safe technique for the management of large bladder calculi. It allows the bladder to collapse over the stone, leading to stone immobilization and, subsequently, decreasing lithotripsy duration. Our procedure is associated with a minimal chance of postoperative urethral injury because all stone fragments are evacuated through the cystoscope sheath, without contact with the urethral urothelium.
authors.affiliation: 1 Department of Urology, School of Medicine, Minia University , Minia, Egypt .
authors.forename: Ahmed Issam
authors.initials: AI
authors.lastname: Ali
authors.affiliation: 1 Department of Urology, School of Medicine, Minia University , Minia, Egypt .
authors.forename: Tarek Khalaf
authors.initials: TK
authors.lastname: Fathelbab
authors.affiliation: 1 Department of Urology, School of Medicine, Minia University , Minia, Egypt .
authors.forename: Amr Mohamed
authors.initials: AM
authors.lastname: Abdelhamid
authors.affiliation: 1 Department of Urology, School of Medicine, Minia University , Minia, Egypt .
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elbadry
authors.affiliation: 2 Jackson Memorial Hospital , Miami, Florida.
authors.forename: Luay
authors.initials: L
authors.lastname: Alshara
authors.affiliation: 1 Department of Urology, School of Medicine, Minia University , Minia, Egypt .
authors.forename: Ahmed Zaki Mohamed
authors.initials: AZ
authors.lastname: Anwar
authors.affiliation: 1 Department of Urology, School of Medicine, Minia University , Minia, Egypt .
authors.forename: Ehab Mohmed
authors.initials: EM
authors.lastname: Galal
authors.affiliation: 1 Department of Urology, School of Medicine, Minia University , Minia, Egypt .
authors.forename: Ehab Rifat
authors.initials: ER
authors.lastname: Tawfiek
mesh_terms: D000328:Adult; D000368:Aged; D020684:Cystoscopes; D003558:Cystoscopy / Q000379:methods*; D004322:Drainage; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000150:complications; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000379:methods*; D001744:Urinary Bladder Calculi / Q000150:complications* / Q000628:therapy*