Percutaneous Cystolitholapaxy Using the LithoClast Trilogy for Multiple Bladder Stones.

Area of Science:

• Urology
• Minimally Invasive Surgery
• Medical Device Technology

Background:

• Traditional management of large bladder calculi includes open cystolithotomy or transurethral procedures.
• Open surgeries pose significant risks for patients with multiple prior operations or high comorbidity burden.
• Percutaneous approaches are effective, particularly for patients with a closed bladder neck.

Purpose of the Study:

• To describe the first reported case of percutaneous cystolitholapaxy using the LithoClast Trilogy device.
• To evaluate the efficacy of this novel device in a complex patient with multiple large bladder calculi.

Main Methods:

• A 41-year-old female patient with spina bifida, ileocystoplasty, Mitrofanoff formation, and bladder neck closure underwent the procedure.
• Percutaneous cystolitholapaxy was performed using the LithoClast Trilogy device for fragmentation and suction of large bladder calculi.
• Calculi characteristics: 31mm and 25mm, volumes of 19.6cm³ and 7.9cm³, HU 408 and 462, composed of calcium phosphate and magnesium ammonium phosphate.

Main Results:

• Successful percutaneous removal of multiple large bladder calculi was achieved using the LithoClast Trilogy device.
• The procedure was performed in a patient with a complex medical history, including a neuropathic bladder and prior reconstructive surgery.
• The LithoClast Trilogy device facilitated efficient fragmentation and suction of the stones.

Conclusions:

• Percutaneous cystolitholapaxy with the LithoClast Trilogy device is a viable alternative to open surgery for complex bladder calculi.
• This approach is particularly beneficial for patients with a history of multiple open surgeries and significant comorbidities.
• The study highlights the potential of novel devices in improving outcomes for challenging urological cases.