Presented by: Rebecca Wales MS4
Warren Alpert Medical School of Brown University

Introduction

The most common treatment for bladder stones includes transurethral cystolitholapaxy which is most frequently done using a holmium laser. Use of ultrasonic and combined lithotripters is routinely used for treatment of renal calculi. Data is limited in use of this technology for the treatment of bladder stones. We present our experience using a combined ultrasonic and an electromagnetic impactor with simultaneous suction to remove stone fragments, in the management of larger bladder calculi. 

Materials

All records of consecutive bladder calculi treated by dual energy lithotripter (LithoClast Trilogy, EMS/Boston Scientific) between 2022 and 2023 were retrospectively reviewed. Procedures were conducted either transurethrally or percutaneously through sheath based on surgeon preference. Data was collected on stone size, number, composition, duration of procedure, additional procedures performed, and surgical complications.   

Results

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Seven consecutive patients – with an average age of 68, of whom one was female - were treated by the Trilogy device between November 2020 and March 2023. The surgical approach used was transurethral for 5 patients and percutaneous for 2 patients. The number of calculi in the bladder ranged from 1-4, and the average size of the largest stone was 35.9 mm, with a range of stone size from 20-60 mm at time of treatment with Trilogy. Procedural times varied from 30 to 159 minutes.

Conclusion

This series demonstrates safety and effectivity of a dual energy lithotripter designed for nephrolithotomy for the management of large bladder calculi. While laser is used effectively for most stones, for large stones, the combination of features available with the Trilogy device make it a useful tool in cystolitholapaxy and may be able to decrease need for open procedures.

Funding

None. 

Lead Authors

Samuel Eaton, MD
Minimally Invasive Urology Institute of the Miriam Hospital, Warren Alpert Medical School of Brown University

Co-Authors

Alexander Homer,
Warren Alpert Medical School of Brown University

Benjamin Ahn,
Warren Alpert Medical School of Brown University

Borivoj Golijanin,
Minimally Invasive Urology Institute of the Miriam Hospital

Rebecca Ortiz,
Minimally Invasive Urology Institute of the Miriam Hospital

Taylor Braunagel,
Minimally Invasive Urology Institute of the Miriam Hospital

Christopher Tucci,
Minimally Invasive Urology Institute of the Miriam Hospital