Urolithiasis in neobladders, particularly in patients with a Mitrofanoff channel, presents a formidable clinical challenge, with recurrence rates approaching 63%. The interplay of urinary stasis, mucus accumulation, and chronic infection fosters an ideal nidus for stone formation. Traditionally managed via open cystolithotomy, such interventions are fraught with morbidity. This study presents a minimally invasive alternative using percutaneous neocystolithotomy.

We present a stepwise, video-accompanied account of a percutaneous cystolithotomy in a 27-year-old male with a history of bladder exstrophy, augmentation cystoplasty, and Mitrofanoff formation. Using a dual-energy single-probe suction lithotripter, an 8 cm struvite stone was completely fragmented and removed via a right iliac fossa approach. The surgical planning was meticulous, accounting for complex abdominal scarring and anatomical distortion.

The procedure achieved complete stone clearance in 150 minutes with no intraoperative complications. Post-operative imaging confirmed successful stone removal. The patient was discharged on day two, continued intermittent self-catheterisation, and underwent daily neobladder irrigations. Stone analysis confirmed struvite composition, aligning with his recurrent UTIs. He remains recurrence-free at follow-up.

Percutaneous cystolithotomy offers a safe, effective, and cosmetically favourable alternative to open surgery in neobladder patients with complex anatomy. This technique should be considered first-line in high-risk patients, with an emphasis on multidisciplinary planning and rigorous postoperative surveillance.