Use of LMA Stonebreaker as an intracorporeal lithotrite in the management of ureteral calculi.

BACKGROUND AND PURPOSE: LMA Stonebreaker is a new type of ballistic intracorporeal lithotrite that does not need external electric power or access to compressed air. It is small and portable. This study aims to evaluate the efficacy, safety, and cost-effectiveness of this lithotrite in the management of ureteral calculi. MATERIALS AND METHODS: A total of 110 patients with ureteral calculi necessitating intracorporeal lithotripsy were prospectively included in the study. The size of the stone, position of the stone, number of shocks needed to fragment the stone to effect complete clearance, and degree of retropulsion were documented in each case, and any evidence of urothelial trauma was noted. RESULTS: All stones were fragmented, and all patients were rendered stone free. The mean number of shocks needed to fragment the stones was eight. The incidence of retropulsion was 6.36%. There was no evidence of urothelial trauma noted in any patient. CONCLUSION: LMA Stonebreaker is a safe, effective, cost-effective, robust, and portable device for intracorporeal lithotripsy.

Cystoscopy-assisted laparoscopic partial cystectomy.

BACKGROUND AND PURPOSE: Laparoscopic partial cystectomy is performed in selected patients with isolated diseases, such as bladder endometriosis, pheochromocytoma, leiomyoma, and malignant bladder tumors. Laparoscopic partial cystectomy is indicated for a solitary bladder tumor that is distant from the bladder neck, the ureteral orifices, and the trigone, to allow a resection margin of 1 to 2 cm. We report our experience with cystoscopy-assisted laparoscopic partial cystectomy. MATERIALS AND METHODS: The bladder was mobilized adequately by laparoscopy. Intraoperative cystoscopy was performed Cystoscopic guidance was used for the initial cystotomy. Further excision of the bladder tumor with a safety margin of 1.5 to 2 cm was performed under laparoscopic vision. RESULTS: Three patients underwent cystoscopy-assisted laparoscopic partial cystectomy. Cystoscopy aided in planning a proper and adequate safety margin around the tumor as well as helped in marking the initial cystotomy. CONCLUSIONS: Cystoscopic assistance during laparoscopic partial cystectomy helps to properly place the initial cystotomy as well aids in planning the safety margin around the tumor. It is safe, easy, and does not add to increased operative time or morbidity.

Ureteroscopic stone management in prepubertal children.

Ureteroscopy for treating ureteric stones in prepubertal children has become more common with the advent of smaller endoscopes. We retrospectively reviewed our experience with ureteroscopy for ureteric stone in this cohort of patients. During the period Jan 2001 and June 2005, we performed 22 ureteroscopic procedures in 20 children. Ureteroscopy was done in a manner similar to that in adults. Ureteral dilatation was done in all cases. A stent was placed postoperatively if there was significant stone burden, ureteral trauma, impaction and edema of ureteric orifice. Of the 20 children, 18 were male and 2 were females. Average age was 5.2 years (range 3-9). Stones were 4-14 mm in size (average 6 mm). Overall 90% of the children were rendered stone free after one procedure and 100% after two procedures. Ureteroscopy for ureteric stones in prepubertal children is safe and effective first line treatment in whom conservative therapy fails. Routine ureteral stent placement postoperatively is not always necessary.