Cystolitholapaxy for large-volume bladder stones using Swiss LithoClast TrilogyⓇ: Initial clinical experience

Objective: Large bladder calculi can be managed with open cystolithotomy, or endoscopically through cystolitholapaxy. The Swiss LithoClast Trilogy is a single-probe dual-energy lithotripter, widely used in percutaneous nephrolithotomy (PCNL). We report our clinical experience including the safety and efficacy of using Trilogy for cystolitholapaxy. Patients and Methods: Patients undergoing cystolitholapaxy using Trilogy since 2020 were identified, and data collected included stone profile, operative details, complications and stone-free status. Radiological stone characterisation was performed for all patients undergoing computed tomography (CT) imaging pre-operatively. Results: There were 41 cystolitholapaxy procedures performed using Trilogy. Average age was 65 years, and 85.4% were male. Average total stone volume was 13.7 cm 3 (SD ±14.6 cm 3 ). The largest stone cleared had a maximal diameter of 4.9 cm and volume of 46.1 cm 3 . Transurethral access via a nephroscope was used in 38 of 41 (92.7%) cases. Average total operating time was 89 minutes (SD ± 40 minutes), and average length of stay was 1.35 days (SD ±2.41 days). Two complications not directly attributable to the use of Trilogy occurred. Conclusion: Cystolitholapaxy using Trilogy is both safe and effective in treating large-volume bladder stones with high complete clearance rates and an excellent safety profile. It should be considered as an alternative to open cystolithotomy. Level of evidence: 4