175 Endourological management of 175 vesical stone a

內視鏡處理175顆膀胱結石– 病例報告 蔡秉浩、張建祥、王百孚、林介山、張進寶、嚴孟意 江恆杰、陳俊吉、黃國軒、石宏仁、黃勝賢、陳建廷 彰化基督教醫院 外科部 泌尿科 Endourological management of 175 vesical stone – a case report Ping-Hao Tsai, Jian-Xiang Zhang, Bai-Fu Wang, Jensen Lin, Chang-Pao Chang, Meng-Yi Yan, Heng-Chieh Chiang, Chun-Chi Chen, Kuo-Hsuan Huang, Hung-Jen Shih, Sheng-Hsien Huang, Jian-ting Chen Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan Introduction: Since the introduction of endourology, open stone procedures has been performed with decrease frequency. Open stone removal procedures have been used in concurrent with other procedures (i. e. vaginal prolapse) or in cases with giant vesical stone. Here we present a case of multiple goblet stones in the bladder being treated with transurethral cystolitholapaxy. Case Presentation: This 81 years old man with history of right staghorn stone, recurring UTI, BPH status post TURP, bladder neck contracture, tongue cancer status post excision and tracheostomy. He was admitted at Nephrology ward due to recurring UTI. KUB during admission showed multiple calcification at bladder region and Urological consultation was ordered. After general anesthesia, the patient was placed on lithotomy position. Transurethral cystolitholapaxy with pneumatic lithotripsy was performed and the remant stones washed out with toomey evacuator. Electronic weighting scales were used to measure the weight of the total washed-out stone fragments (70 grams), then one unfragmented stone were weighted (0. 4 grams). The total number of gobblet stones was estimated by dividing the total weight of stone fragments by the single unfragmented stone (70 gms / 0. 4 gms = 175 stones). Total operative time was 200 minutes. Discussion: Upon reviewing journals on treatment of huge vesical or multiple vesical stone reveal a trend favoring open procedures. As with any disease, surgical intervention should be customized for each different patients with different needs. Some advantages to endourological treatment include: avoiding open wound and the need for cystorrhaphy, the use of spinal or local anesthesia for lower urinary tract stones, and use of natural orifice for stone extraction. Conclusion: With improvement of technology and modern equipments, young Urologist are receiving more training in the field of endourology and less on open procedures. Previous reported cases of multiple vesical stones and giant vesical stone taking the route of open procedures for stone extraction. Upon considering this patient’s underlying disease, we decided on endourologic route to avoid open wound and cystorraphy while achieving similar stone-free rate. Pre-operative KUB Post-operative KUB Stone fragment Total: 70 grams Single pebble: 0. 4 grams Estimated number of stones (175) = 70 / 0. 4 Referrences: 1. A unusual case of 356 vesical calculi. Journal of college of medical sciences-Nepal, 2012, Vol. 8, No. 1, 44 -47 2. Multiple vesical calculi and complete vaginal vault prolapse. Am J Obstet Gynecol. Vol. 189, No. 3 3. Total vaginal prolapse with multiple vesical calculi after hysterectomy. The Journal of Urology. March 1998, Vol. 159, 983