Philippou P et al, 2012: The Management of Bladder Lithiasis in the Modern Era of Endourology

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Philippou P et al, 2012: The Management of Bladder Lithiasis in the Modern Era of Endourology

Philippou P, Moraitis K, Masood J, Junaid I, Buchholz N

Endourology & Stone Services, Barts and The London NHS Trust, West Smithfield, London, UK

Abstract

The recent evolution in the management of vesical lithiasis is a result of the major advancements of modern endourology. The ideal method for achieving stone clearance, however, remains an issue of debate and evidence-based recommendations are lacking. Contemporary literature focuses on management options, such as extracorporeal shockwave lithotripsy, transurethral, percutaneous and minimally-invasive surgery, as well as state-of-the-art energy sources. Issues of particular interest include the results of comparative studies, the management of lithiasis in the paediatric population and the recent challenge of the traditional dogma that dictated BPH surgery for the management of vesical lithiasis secondary to bladder outlet obstruction.

Urology. 2012 May;79(5):980-6. doi: 10.1016/j.urology.2011.09.014. Epub 2011 Nov 25

PMID:22119259[PubMed - as supplied by publisher]

Comment

Bladder stones are not frequently encountered, but their demonstration calls for stone removal. The association between bladder outflow obstruction and stone formation is discussed and it is concluded that a combination of stone removal and pharmacotherapy of BPH sometimes is a reasonable treatment alternative.

In contrast to endourological procedures ESWL causes no trauma to the urethra and might be particularly useful for patients with penile protheses, artificial sphincters and orthotopic neo-bladders.

A procedure is described during which the patient is treated with shockwaves directed from the abdominal side, with a 3-way catheter and with bladder filling of 100-150 mL. The authors report high stone-free rates.

Hans-Göran Tiselius