Use of Amplatz sheath in male urethra during cystolitholapaxy of large bladder calculi

Assess the safety and effectiveness of a novel approach during transurethral pneumatic cystolithotripsy in large urinary bladder stone: quasi-clinical trial

To assess the safety and efficacy of using continuous irrigation-modified hysteroscopy during transurethral pneumatic cystolithotripsy for large bladder calculi. A prospective study was carried out from May 2016 until March 2020. All patients with solitary or multiple bladder stones > 2.5 cm were subjected to Transurethral pneumatic cystolithotripsy using a modified continuous irrigation hysteroscopy, the stone fragments were removed by Ellik Evacuator, the safety and effectiveness of the procedures were evaluated, stone-free rate (SFR), stone recurrence and stricture urethra disease during follow-up. 55 patients with a mean age of 57.36 (22-82) years were included, the male: female ratio was 4:1, single stone in 74.5% and the mean stone size was 52 mm. Lithotripsy time and an operative time were (20.39 ± 3.06 and 32.00 ± 3.57) minutes, respectively. Mean hospital stay was 10 ± 3.6 h. This endoscopic technique succeeded with a 100% SFR. During the 22 months of follow-up, no urethral stricture or stone recurrence was documented. The mean visual analog pain score (VAS) was 4.2 ± 2.1 and 1.4 ± 0.6, respectively, during and after the operation. The use of the modified hysteroscopy sheath during transurethral pneumatic cystolithotripsy is safe and effective for the management of large urinary bladder stones, an alternative to holmium laser in developing countries when laser equipment is unavailable. Comparable to other transurethral maneuvers, with a decrease in the risk of urethral stricture disease due to the small caliber of the device, as there is no urethral dilatation is required.

A prospective evaluation of high- and low-power holmium laser settings for transurethral lithotripsy in the management of adults with large bladder calculi

PURPOSE

To prospectively investigate the efficacy and safety of high-power (100 W) vs low-power (20 W) laser settings for transurethral laser lithotripsy in the management large vesical calculi (> 4 cm).

METHODS

All patients with vesical calculi > 4 cm in the maximum dimension and scheduled for transurethral holmium laser lithotripsy were invited to participate in the study. Every alternate patient was treated with either the low- or high-power laser settings. We used a continuous irrigation resectoscope with laser bridge or a laser working element (Karl Storz) for laser lithotripsy of bladder stones. We compared the operative time, intra-operative/post-operative complications (up to 1 year), and stone-free rates between the treatment groups using IBM SPSS Statistics 24 software. Comparisons between treatment groups for continuous variables were assessed using the Welch test, while categorical variables were compared with either the Chi-square or Fisher's exact test. A p value < 0.05 was considered statistically significant.

RESULTS

Twenty patients with ten in each cohort were recruited. Preoperative data and mean bladder stone size were comparable in both groups. The duration of surgery was significantly reduced from 70.80 ± 25.28 min in low-power cohort to 40.90 ± 15.01 min in the high-power group (p = 0.005). There were no significant intra-operative complications in either group. All patients were stone-free following the procedure.

CONCLUSION

High-power laser setting of up to 100 W results in a significant reduction in duration of surgery without any increase in the complication rate for treatment of large bladder stones.

Management of a Massive Bladder Stone Burden in an Elderly Comorbid Woman via a Transurethral Approach

Here we present the case of a 78-year-old medically comorbid woman with an extremely large bladder stone burden treated by cystolithalopaxy performed using a Swiss LithoClast^® Trilogy Lithotripter (Boston Scientific, Marlborough, MA, USA) through a nephroscope traversing a transurethral Amplatz sheath.

[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.

Large prostatic stones with staghorn renal calculus in a 61-year-old man: an unusual presentation of uncommon disease

Prostatic parenchymal calculi are common in ageing men who are evaluated for benign prostatic hyperplasia or prostate cancer. Giant prostatic calculi are very rare, usually associated with local predisposing factors for urinary stasis and infections, and traditionally managed by open surgery. We present the first case of its kind to be associated with a concurrent staghorn nephrolithiasis, and removed successfully by endoscopic approach using an access sheath through the urethra.

Effect of Amplatz Sheath on Cystolithotripsy for Women with Large Bladder Stone

OBJECTIVE

This study compared the effect of endourological procedures with or without the Amplatz sheath (AS) on cystolithotripsy.

METHODS

We retrospectively analysed 18 patients who underwent treatment for bladder stone over 30 mm. This study consisted of two groups, namely, patients who underwent cystolithotripsy with an AS (AS group) and those who underwent standard procedure without an AS (SP group). The stone-free rate, total energy used for operation, operation time, days of admission after operation, and complication of both groups were compared.

RESULTS

The number of patients in the AS and SP groups was 10 and 8, respectively. Significant differences were not found between these two groups with regard to age, stone burden, stone volume, number of stones, and history of neurogenic bladder. All patients in both groups achieved a stone-free state. Total energy was significantly increased and operation time was shorter in the AS group. No significant difference was observed in terms of days of admission after operation. Any complications were not increased by the use of AS. Struvite was the most common stone component in both groups.

CONCLUSION

Use of an AS can shorten the operation time of cystolithotripsy without increasing perioperative complication.

Transurethral Pneumatic Cystolithotripsy: A Novel Approach

OBJECTIVE

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.

PATIENTS AND METHODS

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.

RESULTS

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.

CONCLUSION

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.

The twin amplatz sheath method: a modified technique of percutaneous cystolithotripsy for large bladder stones in female patients

To minimize the operative time and to avoid open cystolithotomy in women with large bladder stone (>5 cm), we present here a modification of percutaneous cystolithotomy, a well-described standard procedure for urinary bladder stones. With this technique, suprapubic percutaneous access was achieved under cystoscopic guidance. The suprapubic tract was dilated and an Amplatz sheath of 30 Fr was placed. Simultaneously, the urethra was sequentially dilated with fascial dilators and a 28 Fr Amplatz sheath was guided into the bladder and the foot end of the table lowered to 20° to facilitate high-speed outflow of irrigant and stone particles. A 26.5 Fr nephroscope was passed through the suprapubic Amplatz sheath and the stone was fragmented by intracorporeal pneumatic device keeping the stone close to the proximal end of the urethral Amplatz. These maneuvers help in washing out stone fragments periurethrally and keeping the endoscopic vision clear while breaking the stone.

A novel technique for endoscopic management of stones in a continent urinary reservoir

Urinary stones are a well-established complication of lower urinary tract reconstruction in children and can be managed through an open, percutaneous, or transurethral endoscopic approach for their surgical removal. For children with no urethral access, it is not generally advised to pursue an endoscopic approach through a catheterizable channel. In this study, we describe a safe and effective technique for the endoscopic management of stones through a catheterizable channel in a child with a continent urinary reservoir.

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.

Correlation between the operation time using two different power settings of a Ho: YAG laser: laser power doesn't influence lithotripsy time

BACKGROUND

This study investigated the correlation between the operation time using two different power settings of a Ho: YAG laser.

FINDINGS

A total of 68 patients underwent cystolithotripsy from April 2010 to October 2011 In Fifty-six of these patients underwent cystolithotripsy by one surgeon using a Ho: YAG laser for bladder calculi. This study assessed these patients in two groups; the 30 W laser generator group with the settings of 2.5 J x 5 Hz (30 W group) and the 100 W laser generator group as the settings of 3.5 J x 5 Hz (100 W group). The operation time in these two groups were assessed.A total of 56 patients including 45 male and 11 female patients that underwent cystolithotripsy using a Ho: YAG laser for bladder calculi by one surgeon were enrolled in this study. The patients' characteristics including age (mean; 68.8 vs 68.4 yr), gender (male; 74.2 vs 88.0%), stone burden (mean; 34.9 vs 41.3 mm), number of stones (mean; 3.2 vs 2.0) and stone's CT density (mean; 981.5 vs 902.0 HU) showed no significant differences. All patients were stone free following treatment. The median total length of the operation was 19 minutes (mean: 34.6 ± 36.1) in the 30 W group and 29 minutes (mean: 44.4 ± 38.8) in the 100 W group, which was not significantly different.

CONCLUSIONS

The results showed that the power settings of Ho: YAG laser show no differences in the operation time for bladder calculi lithotripsy.

Amplatz sheath for cystolithotripsy using Ho: YAG laser in female patients

OBJECTIVE

To evaluate the effectiveness of cystoscopic lithotripsy, we performed Amplatz sheath technique using Ho: YAG laser. Maheshwari first reported the use of an Amplatz sheath in the female urethra in 1998, and Okeke et al reported the use of an Amplatz sheath for male patients during cystolithotripsy in 2004. The usefulness of the holmium (Ho): yttrium aluminum garnet (YAG) laser lithotripsy is widely accepted, even for large bladder calculi. Since then, there have been no more reports of using the sheath with an Ho: YAG laser.

TECHNICAL CONSIDERATIONS

We inserted the Amplatz sheath conversely. Because of the clear visualization, we used higher laser settings with 2.5 J × 15 to 20 Hz.

RESULTS

We experienced 3 female patients that were successfully treated with the Amplatz sheath technique using Ho: YAG laser lithotripsy. In these 3 patients, whose stone burdens were 4.5, 3.8, and 4.3 cm, they were able to successfully become stone-free with surgeries of 74 minutes, 67 minutes, and 58 minutes, respectively, with no complications.

CONCLUSION

We experienced 3 female patients that were successfully treated with the Amplatz sheath technique using Ho: YAG laser lithotripsy.

[Acute urinary retention in young adult and middle-aged males due to calculi in the urethra: a single centre experience from North India]

OBJECTIVE

To present our experience of managing acute urinary retention (AUR) in young and middle-aged male due to stone/s in the urethra at a tertiary care centre.

MATERIAL AND METHODS

Between July 2004 to April 2011, 102 male patients, young and middle-aged (18-40 years), who suffered from AUR due to calculus in the urethra were managed at our center. Initial management consisted of urethral catheterization or suprapubic trocar cystostomy. Definitive management was performed immediately or after a couple of days depending upon the availability of anesthesia and/or operation theatre. Stone was fragmented by mechanical lithotrite, pneumatic lithotrite or holmium:YAG laser.

RESULTS

All the patients were completely free of their stone/s following the definitive procedure. Voiding trial was successful in all the cases. Postoperative urinary tract infection was observed in eight patients who had undergone immediate endoscopic management. Mild hematuria for approximately 48 hours was noted in six patients who underwent suprapubic cystolithotripsy.

CONCLUSION

Endoscopic management is currently the treatment of choice for stone/s in the urethra which may cause AUR in young and middle-aged male.

The management of bladder lithiasis in the modern era of endourology

The recent evolution in the management of vesical lithiasis is a result of the major advancements of modern endourology. The ideal method for achieving stone clearance, however, remains an issue of debate and evidence-based recommendations are lacking. Contemporary literature focuses on management options, such as extracorporeal shockwave lithotripsy, transurethral, percutaneous and minimally-invasive surgery, as well as state-of-the-art energy sources. Issues of particular interest include the results of comparative studies, the management of lithiasis in the paediatric population and the recent challenge of the traditional dogma that dictated BPH surgery for the management of vesical lithiasis secondary to bladder outlet obstruction.

Comparison of three different endoscopic techniques in management of bladder calculi

Introduction:

We present our experience of comparison of endoscopic treatment of vesical calculus in bladder stone.

Materials and Methods:

This study included 67 patients of bladder stone treated in this hospital from between June 2006 to December 2009 who were randomly assigned in three groups—group 1 (transurethral removal using a nephroscope), group 2 (transurethral removal using a cystoscope), and group 3 (percutaneous removal using a nephroscope).

Results:

Statistical significant difference was observed in operating time—group 1 (32.1+ 8.5 mins), group 2 (69.2 +16.3), and group 3 (46 + 7.3). Statistically significant difference was also observed in the postoperative stay of the patient, which was highest for the group 3 patients. Complete clearance was achieved in all the patients. Group 1 had maximum number of urethral entries as compared to other two groups in consideration.

Conclusions:

Transurethral stone removal using a nephroscope is safe and efficacious method of stone removal without increasing the morbidity of the patients.

The randomized comparison of two different endoscopic techniques in the management of large bladder stones: transurethral use of nephroscope or cystoscope?

PURPOSE

Endoscopic treatment of large bladder stones via cystoscope is still bothersome, and open cystolithotomy is the preferred method in many centers. To gain more insight into the endoscopic bladder stone management, we aimed to compare the transurethral use of nephroscope and cystoscope randomly.

PATIENTS AND METHODS

Forty-three male patients with bladder stones were randomized into two groups, to perform nephroscopic (group 1, n = 22) and cystoscopic (group 2, n = 21) stone fragmentation procedures transurethrally. Combined pneumatic/ultrasonic lithotripsy device was used in both groups to fragment the bladder stones.

RESULTS

The mean stone size in group 1 and group 2 was 3.6 +/- 1.3 cm and 3.5 +/- 1.6 cm, respectively (p > 0.05). Stone fragments were removed completely in all of the patients, and the mean operation time was calculated as 48.2 +/- 13.2 minutes in group 1 and 68.1 +/- 22.7 minutes in group 2, with no intraoperative complications (p < 0.01). None of the patients developed urethral stricture disease in the early (postoperative third month) follow-up. Three patients with previously known urethral stricture disease have shown to have the same disease in the late (postoperative 14.4 +/- 5.1 months) follow-up.

CONCLUSION

Treatment of large bladder stones by transurethrally placed nephroscope is a fast and effective treatment modality compared to endoscopic treatment via cystoscope. Nephroscope allows for use of larger forceps and facilitates collection of large stone fragments through its 24F sheath. It also prevents multiple entries to the urethra and hence avoids possible urethral injury. Combined pneumatic/ultrasonic lithotripsy device, with its aspiration quality, enables the surgeon to gain a better endoscopic view during both procedures.

Simultaneous transurethral cystolithotripsy with holmium laser enucleation of the prostate: a prospective feasibility study and review of literature

OBJECTIVE

To report experience with holmium laser enucleation of the prostate (HoLEP) simultaneously with transurethral holmium laser cystolithotripsy (HLC) for managing bladder outlet obstruction (BOO) and associated vesical calculi; we also review previously reported cases of managing vesical calculi and associated BOO.

PATIENTS AND METHODS

The high-powered holmium laser is a very efficient multifunctional endourological instrument that effectively fragments calculi of all compositions and is capable of haemostatic cutting of tissue, resulting in minimal bleeding after prostatic resection. A prospective study was conducted from April 2003 that included 32 men who underwent simultaneous HoLEP with transurethral HLC at our institution. Demographic, laboratory, peri-operative and follow-up data were analysed. Complications during and after surgery were identified to assess the morbidity of procedure.

RESULTS

The mean (range) size of bladder calculi was 34.6 (12-70) mm and the preoperative weight of the prostate was 51.9 (11-172) g. Combined HoLEP with transurethral HLC was technically feasible in all patients, and all were stone-free after surgery. The mean operative duration was 97.7 (40-230) min, the weight of prostate tissue removed 34.6 (5-88) g, and the duration of catheterization and hospital stay 29.3 h and 34.8 h, respectively. Complications during and after surgery occurred in 12.5% and 15.6% of patients, respectively; all complication were minor and none caused any residual disability to the patient. No patient required a blood transfusion or developed clot retention.

CONCLUSIONS

Managing bladder stones and BOO with simultaneous transurethral HLC and HoLEP should be considered the treatment of choice for such cases. Stones of any size and composition, and prostates of practically any size can be treated endoscopically using the holmium laser, with acceptable morbidity once the technique is mastered. The review of previous reports suggested a need for a prospective study comparing endoscopic management of BOO and associated bladder stones, with medical management of BOO and extracorporeal shock wave lithotripsy/endoscopic lithotripsy for bladder stone.

Bladder lithiasis: from open surgery to lithotripsy

Bladder calculi account for 5% of urinary calculi and usually occur because of bladder outlet obstruction, neurogenic voiding dysfunction, infection, or foreign bodies. Children remain at high risk for developing bladder lithiasis in endemic areas. Males with prostate disease or relevant surgery and women who undergo anti-incontinence surgery are at a higher risk for developing vesical lithiasis. Open surgery remains the main treatment of bladder calculus in children. In adults, the classical treatment for bladder calculi is endoscopic transurethral disintegration with mechanical cystolithotripsy, ultrasound, electrohydraulic lithotripsy, Swiss Lithoclast, and holmium:YAG laser. Novel modifications of these treatment modalities have been used for large calculi. Open and endoscopic surgery requires anesthesia and hospitalization. Alternatively, extracorporeal shock wave lithotripsy has been demonstrated to be simple, effective, and well tolerated in high-risk patients. Recently, simultaneous percutaneous suprapubic and transurethral cystolithotripsy has been tested as well as percutaneous cystolithotomy by using a laparoscopic entrapment sac.

Use of resectoscope to aid in bladder stone extraction

We describe a modified technique of standard cystoscopic manipulation to facilitate bladder stone extraction. This technique decreases the overall time required for stone manipulation by allowing larger size stone fragments to be removed from the urethra under direct visualization.