Analgesia-free flexible ureteroscopic treatment and laser lithotripsy for removal of a large urinary stone: a case report

Journal of Medical Case Reports

Arkadiusz Miernik¹  Alexander Frankenschmidt¹  Konrad Wilhelm¹ 

[1] Department of Urology, University Medical Center, Hugstetterstr. 55, Freiburg, D-79106, Germany

关键词: Urolithiasis;    Ureteral access sheath;    Laser lithotripsy;    Endourology;    Continent urinary diversion;   

Others  :  1233283
DOI  :  10.1186/s13256-015-0699-0

 received in 2015-05-13, accepted in 2015-08-31,  发布年份 2015

【 摘 要 】

Introduction

Urinary stone formation is a frequent complication after continent urinary tract diversion and can require complex surgical management. Therapy options include open, percutaneous, transurethral, or transstomal stone fragmentation and extraction. The transstomal approach is considered to be one of the more complex treatment modalities. The patient’s individual anatomy, minor stoma diameter, and the existing continence mechanism in the majority of cases cause substantial technical challenges for the surgeon. We present here what we believe to be the first description of an analgesia-free flexible endoscopic removal of a large pouch stone in an out-patient care setting. Additionally, we provide a brief overview of competing techniques.

Case presentation

A 30-year-old Caucasian woman with a history of lower urinary tract reconstruction with an ileal pouch and a continent umbilical stoma was admitted to our department with pouch urolithiasis in the urinary reservoir. We employed a minimally invasive approach to extract the stone using flexible ureteroscopy via a modified access sheath and laser lithotripsy. No analgesia is needed with this procedure and it can be performed in an out-patient setting.

Conclusion

The described clinical case highlights the difficulties of treating this high-incidence problem in patients with continent urinary diversions. Our presented technique is of particular interest to urologists and family doctors, and could improve the treatment of such patients by lowering the morbidity of the intervention.

【 授权许可】

   
2015 Wilhelm et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

【 参考文献 】

• [1]Beiko DT, Razvi H. Stones in urinary diversions: update on medical and surgical issues. Curr Opin Urol. 2002; 12:297-303.
• [2]Al-Marhoon MS, Sarhan OM, Awad BA, Helmy T, Ghali A, Dawaba MS. Comparison of endourological and open cystolithotomy in the management of bladder stones in children. J Urol. 2009; 181:2684-8.
• [3]Cohen TD, Streem SB. Minimally invasive endourologic management of calculi in continent urinary reservoirs. Urology. 1994; 43:865-8.
• [4]James OL, Sung J, Marguet C, L’esperance A, Albala DM. The surgical management of stones in patients with urinary diversions. Curr Opin Urol. 2004; 14:129-34.
• [5]Monti PR, de Carvalho JR, Arap S. The Monti procedure: applications and complications. Urology. 2000; 55:616-21.
• [6]Cohen TD, Streem SB, Lammert G. Long-term incidence and risks for recurrent stones following contemporary management of upper tract calculi in patients with a urinary diversion. J Urol. 1996; 155:62-5.
• [7]Claus C, Jorion JI, Libon E. Continent urinary diversion and calculus. Acta Urol Belg. 1997; 65:33-7.
• [8]Rhee AC, Cain MP. Percutaneous cystolithotomy in the pediatric neuropathic bladder with laparoscopic trocar access: a modified approach useful for the augmented and native bladder, and continent urinary reservoir. J Pediatr Urol. 2013; 9:289-92.
• [9]DeFoor W, Minevich E, Reddy P, Sekhon D, Polsky E, Wacksman J et al.. Bladder calculi after augmentation cystoplasty: risk factors and prevention strategies. J Urol. 2004; 172(5 Pt 1):1964-6.
• [10]Miernik A, Schoenthaler M, Wilhelm K, Wetterauer U, Zyczkowski M, Paradysz A et al.. Combined semirigid and flexible ureterorenoscopy via a large ureteral access sheath for kidney stones >2cm: a bicentric prospective assessment. World J Urol. 2014; 32:697-702.
• [11]Vasudevan V, Strine AC, Kaefer M. A novel technique for endoscopic management of stones in a continent urinary reservoir. Urology. 2014; 83:1398-400.