Category: Other, Miscellaneous

VS4-5 - Endoscopic management of Giant Bladder Stones - The Elegant Choice

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective :

Conventional treatment options for giant bladder stones would include open vesicolithotomy or endoscopic cystolithotripsy. The former requires an open surgery, and may not be suitable for patients with multiple comorbids. On the other hand, traditional cystolithotripsy is time consuming, and may require a prolonged surgical time.


ShockPulse™ technology is a lithotripsy system that uses intermittent ballistic shockwave energy coupled with constant ultrasonic shockwave to break down stones. It allows the fragmentation & aspiration of stones simultaneously, which gives a clear operative field and reduces the need for bladder emptying. This technology has been well adopted in the treatment of renal stones via percutaneous nephrolithotomy.


We would like to report a novel use of ShockPulse technology in the management of giant bladder stones. Our institution has performed a total of 5 cases of endoscopic ShockPulse lithotripsy for such stones over a 6 month period (July to December 2017), and have found it to be both feasible and elegant. We report our experience in this, and provide an example of how a giant bladder stone could be cleared endoscopically within a short operative time.


Methods :

A retrospective review of all endoscopic ShockPulse cystolithotripsy performed at our institution was performed. Perioperative parameters such as operative time, length of stay, complications as well as stone parameters such as stone length and density were retrieved and analysed.


Results :

The mean stone length was 4 cm, and the mean stone density as measured on non-contrast CT was 870 Hounsfield Units.  The largest bladder stone measuring 7.1 cm was completely fragmented endoscopically, as depicted in this video.


The mean age of the patients in our series was 74.2 (57 – 86) years, while the mean operative time was 47 (20 – 77) minutes. The median length of hospitalisation was 2 days, and there were no perioperative complications reported. None of the procedures were staged, and the stone free rate was 100%, as confirmed by direct endoscopic visualisation at the end of the procedure.


Conclusions :

ShockPulse lithotripsy offers an advantage in terms of a reduced duration of surgery and hospitalisation stay as compared to open vesicolithotomy or traditional cystolithotripsy. Its use is further exemplified in cases of giant bladder stones, where conventional options may not be ideal. Our institution’s experience in this area is promising, and we hope to extend the use of this technology to more patients with giant bladder stones.

Jin Yong

Resident
Singapore General Hospital
Singapore, Not Applicable, Singapore

Kenneth Chen

Associate Consultant
Singapore General Hospital
Singapore, Not Applicable, Singapore

Allen Sim

Consultant
Singapore General Hospital
Singapore, Not Applicable, Singapore