Percutaneous gallbladder and urinary bladder rotational lithotripsy and a model for gallbladder sclerotherapy after...

In experiments in pigs, fragmentation of stones implanted into the gallbladder and the urinary bladder, respectively, was successfully achieved by mechanical rotational lithotripsy with the Rotolith lithotriptor. The stones could be fragmented into pieces about 1 mm in diameter. Ten patients were selected for percutaneous rotational lithotripsy of gallbladder stones. The procedure was completed in 7 of these 10 patients. Employing a suprapubic approach, the instrument was also used for lithotripsy of urinary bladder stones in 6 male patients. Percutaneous rotational lithotripsy is well suited for elderly patients with symptomatic gallbladder stones and concurrent disease making them high-risk patients for surgery and general anesthesia. Fragmentation of urinary bladder stones in the clinical setting was not as successful as in our experimental series, probably due to the larger volume of the human urinary bladder and the high specific weight of the bladder stones. The feasibility of rotational lithotripsy of urinary bladder stones is conceivable, but when compared with current methods, the use of the Rotolith lithotriptor did not yield any advantage. Ablation of the gallbladder is of great interest to prevent recurrence of cholecystolithiasis after lithotripsy. Rotational lithotripsy of gallbladder stones was performed in an experimental model in 42 pigs to study chemical and thermal sclerotherapy with various agents in edematous gallbladders. A total ablation of the gallbladder mucosa was difficult to effect. Remnants of mucus-producing epithelium persisted in a high percentage of the histologic specimens. Sclerotherapy cannot be considered an effective method for "nonsurgical cholecystectomy."