Endoscopic treatment of continent urinary reservoir calculi.

Formation of calculi is a late complication of continent urinary diversions. The techniques of percutaneous and transstomal treatment of these stones are described. Three patients underwent percutaneous placement of a rigid nephroscope into three different types of continent reservoirs and fragmentation of stones (2-5 cm in size) using ultrasonic lithotripsy. Preoperative CT scan of the abdomen and pelvis with oral and intrareservoir contrast was essential in finding the safest location for percutaneous access. One patient, with small stones, underwent placement of a flexible cystoscope through the continent efferent limb and Holmium laser lithotripsy. There were no instances of reservoir perforation. There was minimal blood loss, with an average operative time of 165 min. Ultrasonic lithotripsy of large stones through a percutaneous approach and Holmium laser lithotripsy for smaller stones via a flexible cystoscope placed through the efferent limb are safe and effective ways to treat calculi within continent urinary diversions.