DIRECT PERCUTANEOUS POUCH CYSTOSTOMY WITH ENDOSCOPIC LITHOTRIPSY FOR CALCULUS IN A CONTINENT URINARY RESERVOIR

Continent urinary reservoirs are an accepted mode of urinary diversion in appropriate patients. Such procedures are associated with long-ter m complications. A patient who underwent a continent urinary diversion (modified Indiana pouch) 4 years ago for a neurogenic bladder present ed with a large irregular calculus in the pouch. Endoscopic attempts t o remove the calculus through the stoma were unsuccessful and extracor poreal shock wave lithotripsy failed to fragment the pouch calculus. F inally, an endoscopic approach through a direct percutaneous pouch cys tostomy, and use of ultrasonic and electrohydraulic probes resulted in successful fragmentation and removal of the calculus.