Abstract

Urolithiasis is a late complication in patients with orthotopic ileal neobladder (Studer) after radical cystectomy, and altered anatomy may limit retrograde endoscopic access. We report three male patients with a history of bladder cancer treated with Studer neobladder reconstruction who developed stones 4–12 years postoperatively. All presented with flank pain, and two had acute pyelonephritis. Computed tomography revealed ureteral stones located at the uretero–ileal anastomosis in all cases; two patients had concomitant ipsilateral renal stones (one renal pelvic stone; one lower calyceal stone associated with a bladder stone). Retrograde ureteroscopy with a semi-rigid scope failed in every patient. Subsequently, mini-percutaneous nephrolithotomy (mini-PCNL) was performed with flexible ureteroscopy for antegrade ureterolithotripsy through the percutaneous tract. No intraoperative or postoperative complications occurred; the drain and urinary catheter were removed on postoperative day 1, and postoperative imaging confirmed stone-free status in all cases. Flexible antegrade ureteroscopy via percutaneous renal access is a safe and effective option for ureteral stones in neobladder patients when retrograde access is unsuccessful.