Electrohydraulic lithotripsy for stones in Kock pouch

During endoscopy of the Kock pouch, we found rather large stones in the pouches of 3 male patients 14-23 months after operation. The size of the stones varied from 1.5 to 3.5 cm. Because the stones in the pouch were too large to be extracted using forceps, for fear of damaging the efferent nipple valve, electrohydraulic lithotripsy (EHL) was applied and all stones could be broken down and removed easily. No complication occurred during or after EHL. Topical anesthesia was not necessary in all 3 patients. Usually the stones formed around staples. The major component of the stones was struvite. Urease-secreting bacteria as well as alkaline urine were found in all 3 patients. This result suggested that though EHL was used in an intestinal milieu (instead of urothelial bladder), it was an easy, safe and effective procedure for the removal of rather large stones (greater than 1.5 cm) from the Kock pouch. We suggest endoscopy of the Kock pouch at least once every 6 months or when stones have been demonstrated on plain X-ray of the abdomen. Stones in the pouch larger than 1.5 cm could be removed using EHL to avoid damaging the efferent nipple valve.