Percutaneous suprapubic cystolithotripsy for treatment of large bladder calculi

Background and Purpose: The treatment options available for managing bladde r calculi include transurethral cystolithotripsy, open cystolithotomy, and shockwave lithotripsy, For larger calculi, transurethral treatment can be t ime consuming, and the manipulation has the potential to cause urethral inj ury. Percutaneous suprapubic cystolithotripsy represents another treatment option for bladder calculi which is effective and minimally invasive. Patients and Methods: Fifteen patients had bladder calculi treated with per cutaneous cystolithotripsy over a 3-year period, The mean stone size was 39 mm (range 10-64 mm), Stones were single in seven patients and multiple in eight patients. The indications for cystolithotripsy were stone size >3 cm, multiple stones >1 cm, and inability to perform transurethral cystolithotr ipsy because of patient anatomy. Percutaneous suprapubic cystolithotripsy w as done through either a 30F or a 36F cystotomy tract. Fragmentation and re moval was performed with a 26F rigid nephroscope and the pneumatic Swiss Li thoclast. Suprapubic and urethral catheters were placed postoperatively in all patients. Results: Each patient was cleared of the stone burden with a single procedu re, and there were no major complications, The mean duration of suprapubic catheterization was 2.6 (range 1-5) days, Conclusion: Percutaneous suprapubic cystolithotripsy is an effective and sa fe technique for treating large bladder calculi, It is minimally invasive, avoids urethral injury, and, in combination with the pneumatic Swiss Lithoc last, can be used to fragment and remove large and hard bladder calculi.