Percutaneous Stone Removal in an Adult with a Continent Cutaneous Reservoir: Case Report and Review of the Literature.

Stone formation is a known long-term complications of continent urinary reservoirs. We present a rare case of a large stone in a continent cutaneous reservoir in a 56-year-old male managed with percutaneous cystolithotomy. The patient presented with recurrent urinary tract infections and stomal incontinence. CT revealed an 8-cm stone occupying the entire lumen of his reservoir. Rather than removing this large stone through an open approach, the pouch was accessed percutaneously and lithotripsy was performed. In this report, we demonstrate our operative technique and that percutaneous cystolithalopaxy may be a safe and effective alternative for the management of large stones within continent cutaneous reservoirs.

Prenatal diagnosis and telemedicine consultation of fetal urologic disorders.

In Arkansas, telemedicine is used commonly in obstetrics through Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS), the existing statewide telemedicine network. This network is used primarily for tele-ultrasound and maternal-fetal medicine consultation. This study is a retrospective case series, describing all the patients who had a prenatally diagnosed urologic anomaly that required prenatal urologic consultation. From 2009-2013, approximately 1300 anomalies were recorded in the Arkansas Fetal Diagnosis and Management (AFDM) database, 14% of which were urologic anomalies. Twenty-six cases required prenatal urologic consultation, 25 of which were conducted via telemedicine. Teleconsultation allowed patients to combine maternal-fetal medicine and urologic consultations in one visit, saving time and effort and ultimately, for most patients, providing reassurance that delivery could be accomplished locally with postnatal follow-up already arranged. While there are several studies reporting the use of telemedicine for various subspecialty consultations, to our knowledge, this is the first to describe the use of telemedicine for prenatal urology consultation. Future research could randomize patients prospectively to allow comparison of both the outcomes as well as the patient experience.