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2011 Wishard Visiting Professor -Vesical CalculiClint Bahler, MD PGY-3, IU Health


5yo female with.. • CC: dysuria, frequency, urgency • HPI: – Began 3 yrs ago with crying upon urination – Enuresis – Occasional episode of straining to urinate

• PMH Measles


Data • PE – – – –

99.5 F poorly nourished Abd- benign SP pain to palpation

• UA, microscopic – – – – –

Slightly alkaline, 200 WBCs, 20 RBCs Phosphate crystals Mucous No casts Colon bacilli, staphylococci

• Imaging..


Roentgenogram (xray)


-Second chairman of dept. Urology after Wishard, Sr -Started the residency program, 1947 -Founding member of the Society for Pediatric Urology


Treatment • Staged lithalopaxy: – Treated pre-op with antiseptic solution (antibiotics not discovered) – “Stone crushing” • Limited to 90 minutes b/c fear of sepsis • 10 grams removed • Bladder irrigations, serial UAs

– 2nd stone crushing, 8grams removed.


Conclusion: • Cysto showing stone removed • Stone composition – M-A-P

• Rapidly gained weight • Dr. Mertz gives 14 reasons for performing lithalopaxy over supra-pubic incision. • First known plubication (100 during his career)


2 weeks ago • CC: SP pain/pressure • HPI/PMH: 29 yo with MMC and neurogenic bladder/bowell s/p bladder augmentation, Monti channel, and colostomy. – – – –

Presents with 4 weeks of of SP pain. No fevers No vomiting No GU followup for 5 yrs


PMH • PMH/PSH: – Hydrocephalous – VP shunt – Rectal prolapse/incont. – Colostomy – Urinary incont – bladder neck reconst. – No history of stones

• Meds – None


Data • PE – Obese/wheelchair bound – Abd- benign, Monti/colostomy healthy

• Urine Culture – 100K Enterococcus, 15K Proteus

• WBC 5, Cr 0.43 • Imaging


Treatment • Cystolithotomy – Through augmented portion – SP tube/Monti catheter, JP drain – Home POD#3

• Stone composition – Brushite


Discussion: Vesical calculi • CT scans? – Low dose

• Treatment? – Open Cystolithotomy – Endoscopic cystolithopaxy – Laparoscopic/trocars – Dilators/30Fr sheath

• Antibiotics? • Postoperative observation.


Vesical Calculi