Large stone in neobladder: percutaneous neocystolithotomy

This article presents the percutaneous management of a large 8 cm neobladder calculus in a 27-year-old male with a history of bladder exstrophy, augmentation cystoplasty, and Mitrofanoff conduit. Urolithiasis presents a heavy burden in patients with urinary diversion, with reported rates of up to 52% and recurrence rates approaching 63% following intervention. In addition to recurrent infections and pain, the unique environment of a neobladder encourages significant calculi growth, necessitating repeat complex surgery. In this patient, his prior open surgery, complex anatomy and reliance on the Mitrofanoff as the sole drainage route deemed open surgery unsafe. Therefore, a minimally invasive neocystolithotomy was performed. Using computed tomography (CT)-guided tract preoperative planning, a tailored extraperitoneal approach was undertaken and a dual-energy lithotripter was employed for approximately 150 minutes. Complete stone clearance of 218 g struvite calculus was achieved without intraoperative or postoperative complications. This case illustrates the safety and efficacy of a minimally invasive approach in patients with complex lower urinary tract reconstructions. Such methods optimise patient outcomes while minimising the risks of injury, perforation and infection associated with the traditional open approach. The report outlines key technical considerations and emphasises the importance of multidisciplinary coordination when managing complex urolithiasis in reconstructed urinary systems.