Bladder stone formation is a challenging complication in patients with recurrent post-traumatic posterior urethral stricture, often due to chronic urinary retention. In cases of complete posterior urethral obliteration, conventional transurethral cystolithotripsy is not feasible. We present a case of post-traumatic posterior urethral obliteration following a failed posterior urethroplasty, complicated by bladder stone formation and chronic localized inflammation, potentially impairing post-reconstruction healing. To address this challenge, we successfully utilized flexible ureterorenoscopy and a flexible ureteral access sheath to perform cystolithotripsy via suprapubic cystostomy, achieving excellent stone clearance.

We present a case of 15 year-old boy who had history of major trauma with severe pelvic fracture, left iliac arteries traumatic dissection, bilateral below knee amputation and traumatic posterior urethral complete disruption with 4.7cm defect. The patient had received delayed posterior urethroplasty, and re-do posterior urethral reconstruction 11 months after initial urethroplasty. However, recurrent urethral stricture with total obliteration of urethral lumen was found at 2 months after second surgery. Cystostomy was insert for salvage treatment. Cystoscopy was performed from cystostomy, which showed multiple small bladder stones with severely inflammatory mucosa. Cystolithotripsy indicated and arranged.

The patient was under general anesthesia and placed in supine position. Suprapubic cystostomy was removed and route was established with insertion of 11Fr flexible ureteral access sheath (ClearPetra, Wellead) under Seldinger technique. We utilized single-use 7.5Fr flexible ureterorenoscope ((HU30S, HugeMed) through the suprapubic flexible access sheath. Laser lithotripsy was performed with Holmium laser. Stone fragments were totally retrieved with stone basket (Dakota Nitinol Stone Retrieval Device, Boston Scientific).

In light of the flexible ureterorenoscopy and flexible access sheaths, these advancements had revolutionized the contemporary management of urolithiasis. Our case demonstrated that utilizing both a flexible ureterorenoscopy and an access sheath through a cystostomy is a feasible and effective approach for managing challenging bladder stones in patients with complete obliteration of the native urethra. This technique expands the therapeutic options for such complex cases, offering a minimally invasive alternative for stone treatment.