Department of Urology, Tanta University, Tanta, Egypt.
J Endourol. 2010 Dec;24(12):2037-41. doi: 10.1089/end.2010.0071. Epub 2010 Oct 7.
Percutaneous endoscopic management of bladder stones is not new. The ideal technique to establish suprapubic access, however, is still not justified. In this study, we used the 12-mm self-retaining laparoscopic trocar for access during management of large bladder stones.
With the patient in the lithotomy position, a 12-mm self-retaining laparoscopic trocar was inserted in a full bladder under cystoscopic visual control. A 28F nephroscope was used to fragment the stone using ultrasound and pneumoclast lithotriptors. After stone treatment, the trocar was left in place, and transurethral resection of the prostate (TURP) was completed when indicated. Both urethral and suprapubic catheters were left at the end of the procedure. Clinical examination, urinalysis, and ultrasonographic examination were routinely performed during follow-up visits.
The mean stone size was 4.07 + 0.20 cm (2.8-6 cm). The average time for stone fragmentation was 32.78 + 2.16 minutes (range 8-53 min). A concomitant TURP was performed in 12 patients. The mean hospital stay was 2.56 + 0.15 days (range 1-4 days). All patients were stone free, and a total of six complications occurred, including extravasation, one patient; hematuria, two patients; and fever, three patients. All were treated conservatively. The mean follow-up time was 15.65 + 1.51 months (range 9-36 mos).
Suprapubic percutaneous cystolithotripsy is a safe, minimally invasive alternative for management of large bladder stones. The use of a self-retaining trocar facilitates access and allows use of a large nephroscope for rapid fragmentation and extraction of the stone fragments. The presence of specific trocars for suprapubic access into the urinary bladder will encourage more transvesical end-laparoscopic procedures.
经皮内镜处理膀胱结石并非新方法。但建立耻骨上通道的理想技术仍未得到证实。在本研究中，我们在处理大膀胱结石时使用 12mm 自固式腹腔镜套管针建立通道。
患者取截石位，在膀胱充盈状态下，在膀胱镜直视下插入 12mm 自固式腹腔镜套管针。使用 28F 肾镜，通过超声和气压弹道碎石器粉碎结石。碎石完成后，套管针保留原位，如需要则进行经尿道前列腺切除术（TURP）。操作结束时，留置尿道和耻骨上导管。术后常规进行临床检查、尿分析和超声检查。
平均结石大小为 4.07 + 0.20cm（2.8-6cm）。碎石平均时间为 32.78 + 2.16 分钟（8-53 分钟）。12 例患者同时行 TURP。平均住院时间为 2.56 + 0.15 天（1-4 天）。所有患者结石均清除，共发生 6 例并发症，包括外渗 1 例，血尿 2 例，发热 3 例。所有患者均经保守治疗。平均随访时间为 15.65 + 1.51 个月（9-36 个月）。
耻骨上经皮膀胱碎石术是处理大膀胱结石的一种安全、微创的替代方法。使用自固式套管针可方便建立通道，并可使用大口径肾镜快速粉碎和取出结石碎片。专用的耻骨上通道套管针将鼓励更多经膀胱的腹腔镜手术。
