Cystolithotomy during robotic radical prostatectomy: Single-stage procedure for concomitant bladder stones

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Abstract

Asymptomatic concomitant vesical calculi are an occasional finding on routine radiologic staging and evaluation of patients with early prostate cancer. We report the first case of single-stage robotic cystolithotomy for multiple bladder stones in a 64-year-old man undergoing robotic-assisted radical prostatectomy, and discuss the approaches available for ensuring complete stone clearance in this unique setting. We show that concomitant bladder stone extraction during robotic-assisted radical prostatectomy is feasible and does not add significantly to operative time. This technique avoids the need to undergo additional general anesthetic procedures with potential complications such as bleeding, urethral stricture formation, and bladder perforation, prior to the prostatectomy.

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Bladder lithiasis: from open surgery to lithotripsy.

Ioannis Varkarakis, A. G. Papatsoris, Athanasios Dellis … (2006)

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.

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Percutaneous cystolithotomy of large urinary-diversion calculi using a combination of laparoscopic and endourologic techniques.

Po N Lam, Charles C Te, Carson Wong … (2007)

Patients with urinary diversions are at higher risk for bladder urolithiasis. Often, the stone burden is large, necessitating open stone removal. We describe our technique for removing such stones using a combination of laparoscopic and endourologic instrumentation. With the patient in the dorsal lithotomy position or supine, cystoscopy is performed via the native urethra or catheterizable stoma, respectively. With the urinary reservoir distended with normal saline, percutaneous access is obtained under direct vision with a 10-mm trocar introduced through the scar of the previous suprapubic cystostomy. A laparoscopic entrapment bag is introduced through the trocar, into which the calculi are manipulated. The bag is delivered percutaneously through the trocar site with subsequent removal of the trocar. A 30F Amplatz renal dilator sheath (Cook Urological, Spencer, IN) is introduced directly into the bag. An ultrasonic lithotrite passed through a nephroscope is utilized to fragment and evacuate the calculi. Closure of the neocystotomy is not performed. A drainage catheter is left in for 7 days. This procedure has been successful in eight consecutive patients, six with bladder augmentations, one with a bladder reconstruction with appendicovesicostomy, and one with an Indiana pouch. All calculi were radiopaque, having a mean linear size of 4.1 cm (range 1.5-7.0) cm. Several patients had multiple stones. The mean operating room time was 123 minutes (range 48-228 minutes). Two patients had concomitant ureteroscopy with laser lithotripsy for ureteral calculi. All were rendered stone free with one procedure and were discharged within 23 hours after surgery. There were no immediate or delayed complications. Our technique of percutaneous cystolithotomy utilizing laparoscopic and endourologic instrumentation is safe and effective for the removal of large calculi from urinary diversions. It is well tolerated, allows complete stone removal in a single sitting, and obviates an open procedure.

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Combined cystolithotomy and transurethral resection of prostate: best management of infravesical obstruction and massive or multiple bladder stones.

Avi Ringel, David Sluzker, S. Richter (2002)

To investigate the results of combined suprapubic cystolithotomy followed by transurethral resection (TUR) of the prostate (TURP) or TUR of the bladder neck in patients with infravesical obstruction and massive or numerous bladder stones. We also reviewed the medical literature and compared the success, morbidity, and mortality rates of the treatment modality presented here and the nonsurgical modality of transurethral lithotripsy and resection of the prostate or bladder neck. Through a 10-year period, 20 men with benign prostatic hyperplasia or bladder neck obstruction and massive or numerous bladder stones underwent cystolithotomy for stone clearance followed by TURP or TUR of the bladder neck. A second group of 20 randomly selected men who underwent TURP alone was studied retrospectively for time of surgery, number of days of postoperative indwelling catheter use, and hospital stay. No deaths occurred. All stones were successfully evacuated (100% stone-free rate). The operative time and number of days of postoperative indwelling catheter use and hospital stay were notoriously shorter in the present series compared with the transurethral lithotripsy and TURP modality. A single case of fever (5% complication rate) occurred in each group. When comparing the data of the present series with a group of 20 men who underwent TURP only, no differences were found in the times of postoperative indwelling catheter use and hospital stay. Cystolithotomy performed before TURP prolonged the total time of surgery an average of 18.4 minutes. In the era of endoscopic and minimally invasive surgery, a small suprapubic cystostomy followed by TURP is still the treatment of choice in cases of infravesical obstruction and very large or numerous bladder stones. The procedure is quick and easy to perform and bears a low morbidity rate compared with transurethral lithotripsy and TURP. A small cystotomy does not prolong the time of indwelling catheter use and hospital stay.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Urol

Journal ID (iso-abbrev): Indian J Urol

Journal ID (publisher-id): IJU

Title: Indian Journal of Urology : IJU : Journal of the Urological Society of India

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0970-1591

ISSN (Electronic): 1998-3824

Publication date (Print): Jan-Mar 2012

Volume: 28

Issue: 1

Pages: 99-101

Affiliations

[1]Department of Urology, Weill Cornell Medical College, York Avenue, New York, USA

Author notes

For correspondence: Dr. Ashutosh Tewari, Department of Urology, Prostate Cancer Institute, James Buchanan Brady Foundation, 525 East 68 ^th Street, Starr 900, New York 100 65, USA. E-mail: ashtewarimd@ 123456gmail.com

Article

Publisher ID: IJU-28-99

DOI: 10.4103/0970-1591.94968

PMC ID: 3339799

PubMed ID: 22557729

SO-VID: 4ca02a82-6475-4ff6-aba5-78999f78938e

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Cystolithotomy during robotic radical prostatectomy: Single-stage procedure for concomitant bladder stones

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Most cited references 4

Bladder lithiasis: from open surgery to lithotripsy.

Percutaneous cystolithotomy of large urinary-diversion calculi using a combination of laparoscopic and endourologic techniques.

Combined cystolithotomy and transurethral resection of prostate: best management of infravesical obstruction and massive or multiple bladder stones.

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