WCE 2019: Super-Mini Laser Cystolithalopaxy: A Useful Approach in those with Challenging Retrograde Access

Abu Dhabi, United Arab Emirates (UroToday.com) In this session, Dr. Hamid Abboudi discussed their experience with a procedure called a super-mini laser cystolithalopaxy. In patients with challenging retrograde access, a 14 French sheath (ClearPetra) that is normally used for PCNL was used to perform a cystolithalopaxy. Usually, when patients with no retrograde access have bladder stones, they are treated with open cystolithotomy or percutaneous cystolithalopaxy. These patients usually have an SP tube or mitrofanoff channel already in place. This access to the bladder was used in their procedure.

This technique provides continuous low-pressure suction and can evacuate small dust particles. The suction vent can be occluded for higher pressure and larger fragment removal. This obviates the need for repeat puncture, which is normally what would be done for patients with no retrograde access.

Dr. Abboudi outlined the technique. First, a guidewire is inserted into the existing tract via the suprapubic catheter. The catheter is removed and the distance from the skin to the bladder is noted. The 14Fr sheath is inserted and the suction tubing is connected to the suction arm of the sheath. Next, a rigid ureteroscope is inserted for laser lithotripsy. The irrigation pressure vs. suction pressure is titrated to optimize the view. The suction vent is occluded to extract large fragments.

They performed this procedure in 4 patients. 3 were done through SP tube tracts and 1 was done through a mitrofanoff channel. No complications were reported, and all patients were stone free by visual examination at the end of the procedure.


This presentation generated some discussion. Continuous flow helps the bladder maintain volume, especially if it is a dysmorphic bladder. A steady state equilibrium can be achieved with the pressures to get a comfortable working medium. This is a case series of a novel procedure that we will be continued, as reported by Dr. Abboudi.

Presented by: Hamid Abboudi, BSc, MBBS, MRCS, PG CERT HBE, Urology, University College London Hospitals, London, United Kingdom.

Written by: Rajiv Karani (Department of Urology, University of California, Irvine) Medical Writer for UroToday.com at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd, Abu Dhabi, United Arab Emirates