Stone entrapment during percutaneous removal of infection stones from a continent diversion

Infection calculi are a frequent complication of continent urinary diversion. Percutaneous removal has become an accepted method for removing these stones. Unfortunately, this technique can be challenging due to mobility of the stones and because small fragments can easily be obscured in the mucosal folds. We describe a modification of the percutaneous technique in which a laparoscopic specimen retrieval bag is used to facilitate removal. CASE HISTORY A 54-year-old man with a history of invasive transitional cell carcinoma of the bladder underwent uncomplicated radical cystoprostatectomy with continent urinary diversion (Indiana pouch). Stones developed within the pouch 3 years postoperatively but the patient was asymptomatic and deferred treatment. The stone burden increased 7 years postoperatively (fig. 1, A) and the patient had recurrent symptomatic urinary tract infections. He was referred to our institution for surgical stone removal. With the patient supine a 16F flexible cystoscope was passed through the stoma of the pouch and 2 large stones were visualized. Under direct vision and ultrasound guidance a 10 mm. laparoscopic trocar was passed into the pouch through a 1 cm. incision (fig. 2). A specimen retrieval laparoscopic bag was deployed through the trocar (fig. 2) and the stones were captured under vision of the flexible cystoscope. The retrieval bag neck was brought through the skin incision, a standard 26F nephroscope was placed, and standard