Case report: the end of “cutting for stone”? Using the Swiss LithoClast® Trilogy for cystolitholapaxy on a 4 cm bladder stone per urethra.

Sninsky B. C. et al. Urology Case Reports vol. 26 (2019) 100964.

Background

The gold standard for managing extremely large or multiple bladder stones is still open cystolithotomy. In general, open surgical procedures are associated with more frequent complications than endoscopic ones. A traditional approach may be very challenging, especially in individuals with specific anatomical or physiological restrictions such as contractures or poor wound healing. Another aspect that has to be taken into account when treating patients with comorbidities is the type of energy used to fragment stones. When using a holmium laser, fragmentation and removing large bladder calculi may require a considerable amount of procedural time and the need for prolonged general anesthesia. Dual-energy lithotripters, on the other hand, present a better efficiency profile. Therefore, Swiss LithoClast® Trilogy - a single-probe device that combines electromagnetic impactor with ultrasonic energy and suction may serve as the best treatment solution in complex cases. 

Patient presentation

A 36-year-old female with chondrodysplasia, paraplegia, contractures, and history of bladder augment, managed with clean intermittent catheterization.

CT scan visualized large bladder stone:

• length: 40 mm
• density: average 1300 HU (indicating hard stone)

Procedure

Taking into consideration the patient's condition and her underlying diseases, cystolitholapaxy was performed with Swiss LithoClast® Trilogy. It took only 43 minutes to complete the stone eradication. The estimated clearance ratio for this hard stone was approximately 500 mm3/min. The post-operative stone assessment showed a composition of 45% calcium phosphate, 40% struvite, and 15% ammonium urate. The entire procedure was well tolerated by the patient, thus she was discharged the next day.

Intraoperative video available: https://www.sciencedirect.com/science/article/pii/S2214442019302529?via%3Dihub#ec1

Conclusion

Swiss LithoClast® Trilogy allows treating large and multiple bladder calculi with faster fragmentation, improved safety, and appropriate surgical field vision. It gives surgeons the opportunity to treat larger stones endoscopically and avoid further complications associated with open procedures. It is a crucial benefit, especially in patients burdened with co-existing diseases.

Article is available under open access, subject to a creative commons license and can be accessed freely: https://doi.org/10.1016/j.eucr.2019.100964