Direct percutaneous pouch cystostomy with endoscopic lithotripsy for calculus in a continent urinary reservoir

Continent urinary reservoirs are an accepted mode of urinary diversion in appropriate patients. Such procedures are associated with long-term complications. A patient who underwent a continent urinary diversion (modified Indiana pouch) 4 years ago for a neurogenic bladder presented with a large irregular calculus in the pouch. Endoscopic attempts to remove the calculus through the stoma were unsuccessful and extracorporeal shock wave lithotripsy failed to fragment the pouch calculus. Finally, an endoscopic approach through a direct percutaneous pouch cystostomy, and use of ultrasonic and electrohydraulic probes resulted in successful fragmentation and removal of the calculus.