Comparison of three techniques in bladder stone surgery: Which technique is more effective and safe?

Background: In our study, we aimed to compare the success and complication rates of percutaneous cystolithotripsy (PCCL), transurethral cystolithotripsy (TUCL), and Ho: YAG laser lithotripsy in the surgery of bladder stones that occurred due to various reasons. Patients and Methods: Patients diagnosed with single or multiple bladder stones with long axis larger than 2 cm, resulting for various reasons, were included in ou study. Sizes of the stones, cystolithotripsy and discharge times, catheter removal times, complications observed, and the visual pain scale (VPS) were retrospectively evaluated separately from the surgical techniques implemented for accompanying patients and their data. Results: TUCL (group 1) was implemented in 40, PCCL (group 2) was implemented in 44, and transurethral Ho: YAG laser lithotripsy (group 3) was implemented in 30 of the 121 patients included in the study. The bladder stone long axe group 1 average was 3,7 cm (2,2-5,3), group 2 average was 3,74 cm (2,1-5,1), and group 3 average was 3,7 cm (2,3-4,7). Urethral stricture evolved in two patients who underwent TUCL. A statistically significant difference was observed on behalf of PCCL in terms of operation time. There was significance in the Ho: YAG laser cystolithotripsy group in comparison with VPS scores. No significant differences were found in terms of age, stone size, urethral catheter removal times, and discharge times. The average follow-up time was 6 months. Conclusion: Although all three methods were quite successful in bladder stone surgery, average cystolithotripsy times were significantly low in the PCCL technique. Thinking that the most common cause of bladder stone is BPH, it is stated that the suprapubic inserted tube ease the bladder drainage during transurethral resection of the prostate (TUR-P). In this way, the duration of the most common accompanying surgeries is shortened and performed more safely.

Robotic partial cystectomy with excision of mesh after inguinal hernia repair: a case report.

BACKGROUND: Mesh erosion into the bladder after hernioplasty is sparsely reported in literature and may be underestimated in clinical practice. We report a case of a patient who was referred to our department due to recurrent urinary tract infections caused by a bladder stone due to mesh migration after inguinal hernia repair 22 years ago. CASE PRESENTATION: A 67-year-old male patient was referred from the outpatient urologist for transurethral resection of the prostate in September 2021 due to recurrent urinary tract infections caused by benign prostatic enlargement and bladder stone formation. During the operation, parts of the stone were smashed and the prostate was resected. Additionally, a mesh eroding from the bladder roof was detected masqueraded by the stone. A computed tomography scan, which was performed afterwards, revealed a 20 × 25 mm mesh migration into the bladder after inguinal hernia repair on the left with concomitant stone adhesion to the mesh. After revealing patient history, an inguinal hernia repair with mesh implantation was done 22 years ago. A robotic assisted partial cystectomy and mesh excision was performed. The patient recovered well. CONCLUSION: Mesh erosion into the urinary bladder after hernia repair can occur up to two decades after the primary operation. Although it is rarely reported, it can be a possible cause for recurrent urinary tract infections and therefore a mentionable complication after inguinal hernia operation. Robotic-assisted laparoscopic partial cystectomy with complete excision of the mesh is an option for definitive treatment.

Bipolar transurethral enucleation of the prostate combined with open cystolithotomy in the treatment of large and giant prostate with bladder stones: Case series.

The surgical management of large or giant prostate still has challenges to urologists, especially if combined with bladder stones, and the traditional techniques by open prostatectomy and cystolithotomy have significant morbidity rates. The endoscopic procedure might not be feasible to treat both conditions in a single procedure, despite advances in surgical techniques and instrumentation, we present a one-session procedure by a combined endoscopic and open approach for treating benign prostatic hyperplasia (BPH) larger than 100 g combined with bladder stones in the elderly patient with other comorbidities. Between May 2017 and January 2020, bipolar transurethral plasma kinetic enucleation of the prostate (TUEP) followed by open cystolithotomy was performed to six patients at our institution, three of them combined with a big bladder stone(s). All the patients have other chronic chest and heart diseases; we retrospectively collected the data. All the patients diagnosed as BPH of big size or giant prostate over 100 g, with bladder stone, and all the patients treated with the same procedure. We founded that the combination methods showed a significant effect in terms of surgery time, patient outcomes and recovery, hospital discharge. The mean age of patients was 78.16 ± 4.2 (73-84) years, and the mean prostate-specific antigen (PSA) value was 16.27 ± 10.01 (8.32-32.17) ng/mL. The mean size of the prostate measured by MRI/US was 266.16 ± 89.1 (169-405) mL. The mean total operation time was 70.5 ± 10.9 (60-90) min, while the mean enucleation time was 28.38 ± 6.61 (23-40) min. The mean intraoperative blood loss was 193.33 ± 19.66 (170-220) mL. The mean resected prostate weight was 217.166 ± 94.67 (117-365) g. The mean post-operative hospital stay was 2.6 ± 0.81 (2-4) days. One patient was readmitted 2 months later due to urinary tract infection, and one patient complains of urine incontinence who spontaneously subsided in 4 months after surgery, other that no severe postoperative complications observed, a significant reduction of serum PSA and IPSS recorded at 3 months, postoperatively. Although simple open prostatectomy remains the reference standard for the treatment. Of excessively large or giant prostatic hyperplasia, the combination procedure not only facilitates the management of selected cases of hyperplasia but further imparts significant benefits to patients and surgeons alike. This treatment plan is safe, time-consuming, and could revolutionize future treatment approaches to giant prostate.

May a comprehensive mineralogical study of a jackstone calculus and some other human bladder stones unveil health and environmental implications?

This paper represents the first result of an active collaboration between the University of Sannio and the San Pio Hospital (Benevento, Italy), started in the 2018, that aims to a detailed mineralogical investigation of urinary stones of patients from Campania region. Herein, selected human bladder stones have been deeply characterized for clinical purposes and environmental biomonitoring, focusing on the importance to evaluate the concentration and distribution of undesired trace elements by means of microscopic techniques in the place of conventional wet chemical analyses. A rare bladder stone with a sea-urchin appearance, known as jackstone calculus, were also investigated (along with bladder stones made of uric acid and brushite) by means a comprehensive analytical approach, including Synchrotron X-ray Diffraction and Simultaneous Thermal Analyses. Main clinical assumptions were inferred according to the morpho-constitutional classification of bladder stones and information about patient's medical history and lifestyle. In most of the analyzed uroliths, undesired trace elements such as copper, cadmium, lead, chromium, mercury and arsenic have been detected and generally attributable to environmental pollution or contaminated food. Simultaneous occurrence of selenium and mercury should denote a methylmercury detoxification process, probably leading to the formation of a very rare HgSe compound known as tiemannite.

Synchronous transurethral cystolitholapaxy and TURP reveals better results than transurethral cystolitholapaxy plus medical therapy for BPH: a randomized prospective study on 100 patients with concomitant urinary bladder stone(s) and BPH.

OBJECTIVE: This report presents the results of a randomized prospective study comparing synchronous transurethral cystolitholapaxy and transurethral resection of the prostate (TURP) with transurethral cystolitholapaxy plus medical treatment for benign prostatic hyperplasia (BPH) in patients with concomitant vesical stone(s) and BPH. PATIENTS AND METHODS: The study included 100 patients with bladder stone(s) < 2.5 cm associated with BPH. Eligible patients were divided randomly into two groups: group I (n = 50 patients) underwent simultaneous transurethral cystolitholapaxy and TURP, and group II (n = 50 patients) underwent transurethral cystolitholapaxy and received postoperative tamsulosin plus finasteride. RESULTS: The mean follow-up was 20.1 ± 5.3 months. No statistically significant differences were found between the 2 groups regarding the preoperative parameters (age, prostatic volume, bladder stone characteristics, prostate-specific antigen level, International Prostate Symptom Score, peak urinary flow rate, and post-void residual urine volume). Both groups experienced statistically significant postoperative improvement in IPSS, post-void residual (PVR) urine volume, and peak flow rate compared with the preoperative parameters (P < 0.001 for all parameters). However, patients in group 1 had a more pronounced improvement (P < 0.001 for all parameters). Thus, 15 patients in group 2 underwent TURP during follow-up. PVR urine and prostate volume predicted the failure of medical therapy and the need for TURP. CONCLUSION: Synchronous transurethral cystolitholapaxy and TURP revealed better results than transurethral cytolitholapaxy plus medical therapy. Cystolitholapaxy without TURP should not be indicated especially in patients with significant PVR urine volumes and larger prostates.

First finding of tiemannite, HgSe, in human bladder stones: An electron microprobe study.

Human bladder stones, surgically removed from a 4 years old boy, were studied by X-ray diffraction (XRD) and by electron microprobe analyses (EPMA). XRD data show that the bladder stones are mainly composed of struvite with minor apatite. Tiny particles, <10 µm in size, composed of mercury (Hg) and selenium (Se) were found using scanning electron microscopy (SEM) and quantitative analysis by wave-length dispersive system (WDS). On the basis of their composition, the particles consist of tiemannite, a rare mineral with the ideal formula HgSe. The young patient was not exposed to relevant mercury contamination and has no teeth fillings of amalgam. Although this observation is not conclusive, we suggest that Hg was introduced as methylmercury by food. The discovered tiemannite can be classified as endogenous mineral, i.e., directly precipitated from the same fluids that formed the host bladder stones. This assumption is supported by the fact that tiemannite and struvite can crystallize at the same temperature and pH values. As proposed for the formation of tiemannite previously reported in the liver of cetaceans, we suggest that the tiemannite in the human body represents a probable product of demethylation of Hg. In this contribution, we suggest that Hg and Se were initially collected by urine in the human body and finally precipitated to form tiemannite under appropriate chemical-physical conditions together with the formation of the host bladder stone. This observation suggests that the precipitation and accumulation of metals, including Hg and Se, in the human body can be considered a physiological response to eliminate part of these trace elements, thus enabling detoxification.

Pediatric vesicolithotomy from ancient India to Greece, Arabia and the western world.

Surgeons removed bladder stones by perineal lithotomy in ancient times. The first surgeon who dared to invade a body cavity knew human anatomy and was skilled in the use of surgical instruments. The operation probably originated in India since the Sushruta Samhita, a surgical text, antedates Hippocrates by several hundred years. Sushruta's knowledge of bladder of stones, surgical complications and instrumentation identifies him as originator of vesicolithotomy. Why did Hippocrates advise his students to leave operations for bladder stones to practitioners who were skilled in the art? Who were these practitioners and how did knowledge of vesicolithotomy reach Greece from India? Our research suggests that the operation came to Greece from India over ancient trade routes and with surgeons who accompanied Alexander the Great's army. The Sushruta Samhita was translated in Arabic and may have reached Europe during the dark ages by way of Arabian surgeons such as Albucasis. Chelseldon, an eighteenth century English surgeon, brought Sushruta's vesicolithotomy to a peak of perfection.

Analysis of Holmium Laser Enucleation of the Prostate in a High-Volume Center: The Impact of Concomitant Holmium Laser Cystolitholapaxy.

Purpose: To assess the influence of holmium laser cystolitholapaxy (HLC) concomitantly with holmium laser prostate enucleation (HoLEP) on patients with benign prostatic hyperplasia (BPH) presenting bladder calculi. Materials and Methods: We present a retrospective analysis of patients with BPH (with or without concomitant HLC) at three Spanish centers. Intraoperative variables (e.g., time and resected tissue), changes in functional parameters of the prostate, and frequency of complications (intraoperative, early postoperative, and at 12 months) in patients with and without HLC were compared. Results: The analysis included 963 patients aged 48 to 91 years, of which 54 (5.6%) underwent HLC to treat vesical lithiasis. Mean (range) prostate size (measured by transrectal ultrasound) was 79 (43-173) g and 91 (35-247) g for patients with and without concomitant HLC, respectively (p = 0.080). All bladder calculi were effectively removed. No significant differences were found regarding enucleation and morcellation times, but total operation time was significantly higher in patients with HLC: mean (standard deviation [SD]) of 78 (27) minutes vs 95 (41) minutes (p < 0.001). Three patients underwent conversion to open surgery because of bladder perforation, all of them from the group without HLC. Rates of intraoperative, early, and 12-month complications were similar in both groups. No significant differences in International Prostate Symptom Scale, maximum flow rate (Qmax), and mean flow were observed between groups 12 months after surgery. Conclusions: Simultaneous HoLEP and HLC increases the total operation time, but does not influence the risk of clinically relevant perioperative and postoperative complications.

Associations of environment, health history, T-zone lymphoma, and T-zone-like cells of undetermined significance: A case-control study of aged Golden Retrievers.

BACKGROUND: T-zone lymphoma (TZL), an indolent disease in older dogs, comprises approximately 12% of lymphomas in dogs. TZL cells exhibit an activated phenotype, indicating the disease may be antigen-driven. Prior research found that asymptomatic aged Golden Retrievers (GLDRs) commonly have populations of T-zone-like cells (phenotypically identical to TZL) of undetermined significance (TZUS). OBJECTIVE: To evaluate associations of inflammatory conditions, TZL and TZUS, using a case-control study of GLDRs. ANIMALS: TZL cases (n = 140), flow cytometrically diagnosed, were identified through Colorado State University's Clinical Immunology Laboratory. Non-TZL dogs, recruited through either a database of owners interested in research participation or the submitting clinics of TZL cases, were subsequently flow cytometrically classified as TZUS (n = 221) or control (n = 147). METHODS: Health history, signalment, environmental, and lifestyle factors were obtained from owner-completed questionnaires. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated using multivariable logistic regression, obtaining separate estimates for TZL and TZUS (versus controls). RESULTS: Hypothyroidism (OR, 0.3; 95% CI, 0.1-0.7), omega-3 supplementation (OR, 0.3; 95% CI, 0.1-0.6), and mange (OR, 5.5; 95% CI, 1.4-21.1) were significantly associated with TZL. Gastrointestinal disease (OR, 2.4; 95% CI, 0.98-5.8) had nonsignificantly increased TZL odds. Two shared associations for TZL and TZUS were identified: bladder infection or calculi (TZL OR, 3.5; 95% CI, 0.96-12.7; TZUS OR, 5.1; 95% CI, 1.9-13.7) and eye disease (TZL OR, 2.3; 95% CI, 0.97-5.2; TZUS OR, 1.9; 95% CI, 0.99-3.8). CONCLUSIONS AND CLINICAL IMPORTANCE: These findings may elucidate pathways involved in TZUS risk and progression from TZUS to TZL. Further investigation into the protective association of omega-3 supplements is warranted.

Jack stone in the bladder: case report of a rare entity.

BACKGROUND: Jackstone is a bladder stone that has a similar appearance to toy jacks. However review of the English language medical literature revealed only a few previous reports of jackstone calculus. CASE PRESENTATION: We report a case in which a large jackstone calculus was incidentally detected during the evaluation of 67 year old male presenting with lower urinary tract symptoms. X-Ray kidney, ureter, bladder showed a large irregular shaped radio-opaque shadow in the pelvic region. He underwent cystolitholapaxy and transurethral resection of the prostate. CONCLUSION: It is important to recognize the characteristic shape of the urinary bladder calculi in the diagnosis of the jack stones and to treat the primary cause of calculi formation.

Shockwave lithotripsy with music: Less painful and more satisfactory treatment. / Litotricia por ondas de choque con música: un tratamiento menos doloroso y más satisfactorio.

INTRODUCTION: The objective of this study was to determine whether listening to music during a session of extracorporeal shockwave lithotripsy (ESWL) improves patients' pain. MATERIAL AND METHOD: A simple, blind randomisation was undertaken of patients with kidney and ureter stones attending an ESWL session of 7,000 waves for the first time, between September and December 2014. One group was given music and the other was not. The age, gender, location of stones (kidney/ureter) were recorded and 2questionnaires: pre ESWL (questionnaire A) and postESWL (questionnaire B). Each questionnaire contained a question about anxiety and another question on pain on the Likert scale (0-10). Questionnaire B also had a question on satisfaction and comfort (Likert 0-10). Other variables included heart rate, respiratory rate, systolic and diastolic blood pressure on wave 2,000, 5,000 and 7,000, reason for halting the procedure, total pethidine (mg), secondary analgesia, energy (J) and frequency (Hz). Bivariate analysis using the Student's t-test, X2/Fisher test and a multiple linear regression model. RESULTS: The sample comprised 95 patients, with a mean age of 52 (±13) years, 35 (36.84%) females, 60 (63.2%) males. A total of 25 (26.3%) ureter stones and 70 (73.7%) kidney stones. A number of 42 (44.2%) patients were given music. There were no differences between the demographic variables or questionnaire A scores. Satisfaction and pain were better on questionnaire B with music. CONCLUSION: Music can reduce pain and improve patient satisfaction in ESWL treatment. More studies are required to confirm this effect.

Correlation of benign prostatic obstruction-related complications with clinical outcomes in patients after transurethral resection of the prostate.

We aim to investigate the correlation of benign prostatic obstruction (BPO)-related complications with clinical outcomes in patients after transurethral resection of the prostate in China. We reviewed the medical history of all patients who underwent surgery from 1992 to 2013. We assessed the preoperative clinical profile, clinical management, and operative complications. Overall, 2271 patients were enrolled in the study. Of these patients, 1193 (52.5%) had no BPO-related complications and 1078 (46.3%) had BPO-related complications. Compared with patients without BPO-related complications, those with BPO-related complications were older (p = 0.001) and usually had other urologic comorbidities (p = 0.003). Additionally, they tended to have more tissue resected (p < 0.001), a higher American Society of Anesthesiologists grade (p = 0.002), and larger prostates (p < 0.001). Nonetheless, there was no obvious difference in surgical complications between both groups (p > 0.05). Among patients with BPO-related complications, compared with the bladder stone group, only the bladder stone+ group tended to have a greater urinary infection risk after transurethral resection of the prostate. Compared with patients with one or two BPO-related complications, those with three BPO-related complications tended to have a higher risk of pulmonary embolism and acute coronary syndrome (p < 0.05). Despite the widespread use of medication, patients with BPO-related complications were older and had larger prostates; however, transurethral resection of the prostate is still considered a safe and recommended surgical treatment. Nevertheless, those with three or more complications were at a higher risk of severe complication after surgery, and active surgical intervention is needed once BPO-related complications develop.

Comparison of Ho:Yag laser and pneumatic lithotripsy combined with transurethral prostatectomy in high burden bladder stones with benign prostatic hyperplasia.

OBJECTIVES: To compare the efficacy and reliability of Ho:YAG laser lithotripsy (HLL) and pneumatic lithotripsy (PL) in the treatment of bladder stones in patients with benign prostatic hyperplasia and stones ≥ 20 mm who were transurethrally treated in the same surgical session. METHODS: We studied the data of patients with benign prostatic hyperplasia and ≥20 mm bladder stones who were treated with transurethral resection of the prostate and cystolithotripsy in the same session, obtained between January 2010 and February 2014 from three urology clinics. All patients underwent bipolar plasmakinetic (PK) transurethral resection of the prostate. For treatment of the bladder stone, either HLL or PL was applied. A total of 62 patients were divided into two groups: PK-PL (Group 1, n = 29) and PK-HLL (Group 2, n = 33). The data of both groups were analyzed for stone dimensions, stone fragmentation time, total operating time, hospitalization duration, prostate dimensions, success rates, and complications. RESULTS: Group 1 included 29 patients with a mean age of 70 ± 7.6 (range, 57-85) years, whereas Group 2 included 33 patients with a mean age of 67.5 ± 10.5 (range, 45-84) years. In Group 1, five patients had mucosa injury, one patient had residual stone, and one patient had bladder perforation. In Group 2, three patients had mucosa injury, three patients had postoperative fever, and one patient had residual stone. Total operation time and stone fragmentation time were significantly lower in Group 2 (p < 0.05). The remaining analyzed data were similar (p > 0.05). CONCLUSION: PK-HLL using a single shaft without the need for repeated access has the advantages of shorter fragmentation and operation time.

A Modified Technique for Performing Transurethral Resection of the Prostate Combined with Percutaneous Cystolithotripsy.

INTRODUCTION: This study aimed to determine the safety and efficacy of a modified technique for performing transurethral resection of the prostate (TURP) combined with percutaneous cystolithotripsy (PCCL). METHODS: Clinical data from 24 patients with benign prostate hyperplasia (BPH) and aggregate stone sizes ≥3 cm were assessed retrospectively between June 2011 and January 2014. All stones fragmented via pneumatic lithotripter were removed. An 18-F Foley catheter was inserted into the Amplatz sheath, which was then removed from the bladder. The Foley catheter balloon was inflated with 15 ml of saline, and suprapubic traction was applied to prevent extravasation. Next, TURP was performed while a suprapubic Foley catheter provided continuous drainage. RESULTS: The mean stone size was 46.25 ± 9.51 mm. The surgical duration for stone removal was 31.25 ± 8.46 min. All patients were stone-free at the first month follow-up. None of the patients experienced extravasation or urethral stricture. CONCLUSIONS: PCCL is a short-duration, minimally invasive surgery that avoids urethral stricture. In the presented technique, as the drainage catheter is fixed to the dome of bladder, it is not visualized in the surgical field and remains outside of the resection area, which facilitates prostate resection. It seems to be a safe and efficient technique.

Application of the holmium laser lithotripsy for bladder stones under local anaesthesia: a prospective analysis.

PURPOSE: The purpose of this study is to determine the feasibility and the results of intracorporal holmium laser (HL) lithotripsy in patients with bladder calculus under local anaesthesia. MATERIALS AND METHODS: From January 2009 to August 2012, 46 patients underwent HL lithotripsy for bladder calculus under local anaesthesia. Twelve patients who had associated medical comorbidity also underwent the procedure. The pain was evaluated with 10-point visual analogue scale during and 1 h after completion of the procedure. Foley catheter was inserted at the end of procedure in all the patients. RESULTS: In the present study, the mean stone size was 2.1 cm (1.1-4.2 cm) and the mean operative time was 43 min (range 23-57 min). All patients were rendered stone-free in a single sitting except one patient. The mean pain score intraoperatively and in the postoperative period was 3.84 and 1.47, respectively. There was no major complication during surgery. The procedure was well tolerated and most of the patients were discharged on the same day. After the follow-up period of 3 months, all patients were asymptomatic except one patient who developed a soft stricture in the bulbar urethra and was managed by internal urethrotomy. CONCLUSIONS: Bladder stones can be safely managed by HL lithotripsy under local anaesthesia with a high success rate and minimal morbidity. The procedure is even feasible in high-risk patients with medical comorbidities without extra risk.

Intravesical prostatic protrusion is a risk factor for bladder stone in patients with benign prostatic hyperplasia.

OBJECTIVE: To assess the risk factor that influences bladder stone formation in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: We reviewed the data of 271 consecutive patients with BPH who underwent transurethral resection of the prostate between January 2008 and December 2012. Patients were classified into 2 groups based on the presence of a bladder stone: Group 1 had a bladder stone and group 2 did not. Univariate analysis was performed to determine the association between the presence of bladder stone and the patients' age, body mass index, International Prostate Symptom Score, total prostate volume (TPV), transitional zone volume, intravesical prostatic protrusion (IPP), uroflow parameters, and urodynamic parameters. RESULTS: The overall rate of bladder stone in patients with BPH was 9.9%. The patients' body mass index, International Prostate Symptom Score, and urodynamic parameters did not significantly differ between the 2 groups. The patients' age, TPV, transitional zone volume, and IPP were all significantly higher and the Qmax was significantly lower in group 1 than that in group 2. Multivariate analysis revealed that age (hazard ratio [HR] = 1.089; P = .020), IPP (HR = 1.145; P <.001), and Qmax (HR = 0.866; P = .019) significantly affected the presence of bladder stone in patients with BPH. A predictive model using logistic regression for bladder stone in BPH patients was defined as follows: probability = 1/[1 + exp (-8.499 + 0.085 (age) + 0.009 (TPV) + 0.136 (IPP) - 0.143 (Qmax))] with area under the curve of 0.850 obtained from the receiver operating characteristic curve analysis. CONCLUSION: This study demonstrated that older age, longer IPP, and lower Qmax are independent factors that associated with the presence of bladder stone in patients with BPH.

The initial experience of pneumovesicoscopic bladder stone removal using a laparoscopic entrapment sac.

INTRODUCTION: In this article, we aim to present our novel experience of bladder stone removal under pneumovesicoscopic field using a laparoscopic entrapment sac. TECHNICAL CONSIDERATIONS: We retrospectively reviewed the medical records of 21 patients who had pneumovesicoscopic bladder stone removal to assess a variety of patient characteristics and surgical outcomes. We considered stone burden, stone removal time including pneumovesicoscopic procedure time, postoperative catheter indwelling duration, postoperative hospital stay, and complications. The procedure was performed in the following steps: Under cystoscopy filled with saline solution, a 10-mm suprapubic transvesical trocar was inserted. After changing optical transmission medium from saline to CO(2) gas, pneumovesicoscopic procedure was performed to put stones in an entrapment sac inserted through the trocar. The stones trapped in the sac were extracorporeally broken with a lithotripter via the suprapubic route. The mean patient age was 58.95 ± 22.03 years. The mean stone burden was 4.88 ± 2.63 cm. Eleven patients had a single stone, whereas 10 had multiple stones. All stones were completely removed. The mean operative time was 31.66 ± 7.25 minutes, including the pneumovesicoscopic procedure time of 13.81 ± 7.30 minutes. In all but 6 patients with a cystostomy or a combined transurethral resection of the prostate, the urethra catheter was removed on the day after surgery; the mean postoperative hospital stay was 1.67 ± 0.49 days. There were 5 postoperative complications of Clavien grade I or II. CONCLUSION: We report the technical feasibility of pneumovesicoscopic bladder stone removal using a laparoscopic entrapment sac as a minimally invasive method. This technique will likely become more important as a useful option for treating bladder stones.

Repeated spinal anesthesia in a tetraparetic patient with Guillain-Barré syndrome.

A 78 year old man with tetraparesis, reduced forced vital capacity, and neurogenic bladder dysfunction due to Guillain-Barré syndrome was admitted for elective transurethral prostate resection and percutaneous lithotripsy of a bladder stone. On the sixth postoperative day, he was readmitted for emergency evacuation of a clot in the bladder. Both operations were performed with spinal anesthesia (hyperbaric bupivacaine + fentanyl) without neurologic sequelae.

Minimally invasive surgery for patients with bulky bladder stones and large benign prostatic hyperplasia simultaneously: a novel design.

OBJECTIVE: To determine the efficacy and safety of a novel minimally invasive design for treating bulky vesical calculi and large benign prostatic hyperplasia (BPH) simultaneously. METHODS: 76 patients with large bladder stones (>4 cm) and large BPH (≥50 cm³) were treated from August 2008 to January 2011. 38 patients (group 1) underwent transurethral cystolithotripsy followed by transurethral resection of the prostate (TURP), 38 patients (group 2) received percutaneous cystolithotripsy within a laparoscopic entrapment bag and TURP by two surgeons simultaneously. 72 patients were followed up for 1 year. Patient demographics, perioperative parameters and follow-up data were compared. RESULTS: Patient baseline characteristics were comparable in the two groups. In group 1, 3 patients converted to open surgery and received blood transfusion, 4 patients had postoperative fever, 2 had residual stones and 1 developed urethral stricture postoperatively. In group 2, the mean total operative and the operative times for stone management were 71.6 and 30.1 min, respectively, the mean hemoglobin decrease was 0.80 g/dl, no patients received blood transfusion and no complications occurred, significantly superior to group 1. CONCLUSIONS: Percutaneous cystolithotripsy using a laparoscopic entrapment bag associated with TURP by two surgeons simultaneously is a highly effective, safe and minimally invasive method for managing large vesical calculi and large BPH.

[Transurethral plasmakinetic enucleation of prostate and suprapubic small cut in the treatment of high risk and senior patient with benign prostatic hyperplasia and bladder stones].

OBJECTIVE: To explore the safety and efficiency of transurethral plasmakinetic enucleation of prostate (TUPKEP) and suprapubic small cut in the treatment of high-risk and senior patients with benign prostatic hyperplasia and bladder stones. METHODS: A retrospective review was conducted for 68 high-risk and senior patients with benign prostatic hyperplasia and bladder stones. All of them were treated by TUPKEP and suprapubic small cut. RESULTS: Operation was successfully performed in all 68 cases. And there was no instance of transurethral resection syndrome, shock, myocardial infarct, cerebral infarction, cerebral hemorrhage, permanent urinary incontinence or surgical site infection. Seven patients with temporal urinary incontinence recovered at a mean time of (9.48 ± 1.52) days post-operation. The mean operative duration was (48.63 ± 4.14) min and the mean volume of blood loss (50.97 ± 5.33) ml. The changes of maximum flow rate (Qmax), international prostatic symptom score (I-PSS) and quality-of-life (QOL) were statistically significant before and after operation. Qmax increased from (4.56 ± 0.35) to (18.82 ± 1.65) ml/s (P < 0.001), I-PSS decreased form (21.96 ± 1.89) to (11.23 ± 0.86) (P = 0.018) and QOL decreased from (4.94 ± 0.35) to (1.95 ± 0.32) (P = 0.011). CONCLUSION: The approach of TUPKEP and suprapubic small cut is both safe and effective in the treatment of high-risk and senior patient with benign prostatic hyperplasia and bladder stones and should be widely applied.