V1727: Percutaneous Management of Large Bladder Stones Using an Entrapment Bag

Video

Introduction and Objectives
Large bladder calculi pose a therapeutic dilemma. Open surgery has traditionally been used for stones that are too large to treat endoscopically. Percutaneous techniques have also been used, but can be tedious and can result in injury to the bladder mucosa, due to trauma from lithotripsy devices, and residual fragments. This video demonstrates a technique we devised utilizing percutaneous access, an offset lens nephroscope, and a laparoscopic entrapment bag to minimize bladder injury while expeditiously removing large stone burdens that would normally require open surgery for extraction

Methods
This method was performed prospectively on 13 patients with standard percutaneous nephrolithotomy equipment and a laparoscopic Endocatch bag. Percutaneous access into the bladder, entrapment of stones and deployment of endocatch bag were all achieved under direct vision with flexible cystoscope. Next, stone comminution was performed with mechanical or ultrasonic lithotripters and the Endocatch bag was removed intact with all stone fragments, finally a suprapubic catheter was inserted.

Results
In all cases there was minimal trauma to the bladder mucosa. The mean combined diameter of stones was 8.9cm and a mean of 4.4 stones was extracted from each bladder. Mean surgical time was 93.1 minutes and length of stay was less than 24 hours in all patients.

Conclusions
Minimally invasive percutaneous cystolithotomy with a laparoscopic entrapment bag provides for an efficient treatment modality for the extraction of large volume bladder stones with minimal trauma to the bladder mucosa or the urethra.

Funding: Institutional