PTU - Polskie Towarzystwo Urologiczne
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Percutaneous cystolithotripsy and cystolitholapaxy - PCCL
Article published in Urologia Polska 2001/54/2.

authors

Piotr Chłosta, Artur A. Antoniewicz, Grzegorz Kata, Tomasz Szopiński, Andrzej Borówka
Piotr Chłosta, Artur A. Antoniewicz, Grzegorz Kata, Tomasz Szopiński, Andrzej Borówka

keywords

urinary bladder, bladder stones, percutaneous cystolithotripsy

summary

INTRODUCTION & OBJECTIVES: Bladder stones are usually a consequence of bladder outlet obstmction caused by BPH. and are one from absolute indications to surgical treatment BPH. Intervention on BPH and bladder stones patients including contemporary stones removal from bladder and to elimination of bladder outlet obstmction. Surgery is usually performed by urethra: cystolithotripsy and transurethral resection of the prostate (TURP). In the case of large stones mass, cystolihotomy and OPSU (open prostatic surgery) should be performed. A new alternative treatment is percutaneous cystolithotripsy (PCCL) performed by one surgeon under transurethral video-control via percutaneous approach (cystostomy stabilised by an Amplatz tube). All types of endolithotripsy (sono-trode, Lithoclast. EHL) may be used. Majority of stone fragments are removed by forceps trough Amplatz tube, resistant fragments should be sucked off. TURP is performed after PCCL. with holding an Amplatz tube in cysto-stomic channel. After completing PCCLYTURP the 24-26F Couvelaire catheter is left in the suprapubic cystostomy, while the second catheter is inserted transurethrally .
MATERIAL & METHODS: Between 1995 - 1999 47 patients aged ranging from 53 to 91 underwent a new technique. In 35 cases TURP was performed directly after PCCL and in 8 cases PCCL was followed by TUIP. In 4 patients an internal endoscopic urethrotomy was necessary. Suprapubic catheter was removed after outflow 1-4 days after PCCL, and transurethral catheter was removed 1-2 days later.
RESULTS: Mean stone mass removed was 80 g ( from 60 g to 120 g). Duration of the procedure was 20 to 90 minutes (average 45 of minutes). In all cases PCCL was absolutely successful. Complications stepped out at 4 patients.
CONCLUSIONS: PCCL is a safe, fast and efficacious minimally invasive method of bladder stone removal: all stones including big stone fragments can be easy removed. TURP following PCCL is shorter than standard procedure, urethral wall is protected (removing of stones from bladder through Amplatz tube diminishes danger of damage of membrane of mucous ure(hra). TUR syndrome is avoided: executing TURP immediately after PCCL, at presences Amplatz tube, eliminates risk of height intravesical pressure of irrigant .

references

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correspondence

dr med. Piotr Chłosta. F.E.B.U.
Oddział Urologii Szpitala Kolejowego we Wroclawiu Al. Wi¶niowa 36
e-mail: Piotr.Chlosta@psi.wroc.pl
tel/fax: (071) 369 20 08