V9-13: Laser Poucho-litholapaxy, a minimal invasive treatment for giant neobladder calculi
VideoIntroductions and Objectives
Open poucho-lithotomy is a commonly used treatment modality for large neobladder calculi. In elderly patients many years after urine diversion, laser poucho-litholapaxy seems to be an appealing alternative. In this video, we aimed at showing the technical aspects used in treatment of giant neobladder stones using Homium: YAG laser.
The electronic files of patients who were treated with orthotopic neobladders were reviewed for patients with neobladder calculi. Cases with giant calculi (≥5cm) were identified.
Out of 1965 patients with ileal based neobladder, 130 developed pouch stones with 190 pouch stone episodes. Giant reservoir stones were found in 17 patients, 12 patients were treated with open poucholithotomy and 5 patients were treated with laser poucho-litholapaxy. No complications were encountered during laser procedures however, 3 cases were complicated with small intestinal injury upon open procedures. Slightly longer operating time (median, range) was found in laser procedure (136, 118-158 mins for laser vs. 109, 102-169 mins for open, P=0.06). Significantly shorter hospital stay (1 day for laser vs. 7, 3-10 days for open, P=0.00) and time to catheter removal (1 day for laser vs. 7, 5-15 days for open, P=0.00) was found in laser procedures.
Laser poucho-litholapaxy is a safe and effective treatment modality for giant reservoir stones and is associated with limited morbidity, shorter hospital stay and time to catheter removal.