Transurethral Approach for Management of Large Stone Formed on Staples in a Female Patient With Orthotopic Neobladder Assisted by Transurethral Amplatz Sheath and LithoClast Trilogy

Bladder stones occurring in orthotopic neobladders are remote late complications with a reported incidence of 5%. They can be managed with open, endoscopic, or robotic‐assisted approaches. A transurethral endoscopic approach is usually offered for smaller stone burdens, while larger stones are often treated by a percutaneous endoscopic or open approach. In this report, we describe the case of a 78‐year‐old female who presented with complaints of urge urinary incontinence and nocturnal enuresis and was diagnosed with a 5 × 4.9 × 4.9 cm stone in her orthotopic neobladder 13 years after radical cystectomy for bladder cancer. She underwent transurethral endoscopic management of her neobladder stone with the assistance of a transurethral Amplatz sheath and Trilogy lithotripsy. The stone had metal staples as a nidus, and total operation time was 183 min. Follow‐up CT scan showed complete resolution of the stone. At 9‐month follow‐up, the patient remained symptom‐free on regular clean self‐catheterization of the bladder. This case report shows the feasibility, safety, and efficacy of using the transurethral Amplatz sheath and Trilogy for the management of large stones in orthotopic neobladders. We believe that this approach may be an alternative to more invasive open surgical or percutaneous management of large stones in orthotopic neobladders in female patients.