Endoscopic Management of Large Vesical Calculus

Vesical calculi are the most commonly observed lower urinary tract stones. Traditionally, large vesical calculi (>4 cm) have been managed via open surgical procedures like cystolithotomy. However, advancements in urology have introduced minimally invasive techniques, including cystolitholapaxy, percutaneous cystolithotomy, cystolithotripsy, and extracorporeal shock wave lithotripsy (ESWL). This study aimed to share our experience in managing large vesical calculi through endoscopic approaches, particularly in cases where cystolithotomy was not feasible due to prior bladder surgeries. The study included nine patients with vesical calculi exceeding 4 cm. All had a history of open bladder surgery, such as cystolithotomy, with one female patient having undergone vesicovaginal fistula repair twice. Initial fragmentation of stones into 3–4 pieces was achieved using a holmium laser to create smaller, rougher surfaces, facilitating subsequent removal with a lapaxy punch. Complete stone clearance was achieved in all patients without requiring ancillary procedures. Catheters were removed within 24 hours post-procedure. This combined approach using a holmium laser and cystolitholapaxy punch demonstrates an effective, minimally invasive option for managing large vesical calculi in complex cases with prior bladder surgeries.