Minimally Invasive Management of Bladder Stones in Children

Abstract

Background: Bladder stones (BS) are rare in children. Minimally invasive surgery (MIS) seems to be nowadays the procedure of choice to treat pediatric patients with BS. This study aimed to analyze retrospectively our experience with percutaneous cystolithotomy, endourological treatment with Holmium laser and robotic cystolithotomy in children with BS.Methods: We retrospectively analyzed the data of 13 children (eight boys and five girls) with BS who were treated at our centers between July 2013 and July 2020. The patients received three different MIS procedures for stones removal: five underwent robotic cystolithotomy, five underwent endourological treatment and three received percutaneous cystolithotomy (PCCL). We preferentially adopted endourological approach for stones <10 mm, percutaneous approach between 2014 and 2016 and robotic approach since 2016 for larger stones.Results: Mean patients' age at the time of diagnosis was 13 years (range 5–18). Ten/13 patients (76.9%) had primary BS and 3/13 patients (23.1%) had secondary BS. Mean stone size was 18.8 mm (range 7–50). In all cases the stones were removed successfully. One Clavien II post-operative complication occurred following PCCL (33.3%). All the procedures were completed without conversions. Operative time ranged between 40 and 90 min (mean 66) with no significant difference between the three methods (p = 0.8). Indwelling bladder catheter duration was significantly longer after PCCL (mean 72 h) compared with robotic and endourological approaches (mean 15.6 h) (p = 0.001). Hospitalization was significantly longer after PCCL (mean 7.6 days) compared with the other two approaches (mean 4.7 days) (p = 0.001). The endourological approach was the most cost-effective method compared with the other two approaches (p = 0.001).Conclusions: Minimally invasive management of bladder stones in children was safe and effective. Endourological management was the most cost-effective method, allowing a shorter hospital stay compared with the other procedures but it was mainly indicated for smaller stones with a diameter < 10 mm. Based upon our preliminary results, robotic surgery seemed to be a feasible treatment option for BS larger than 15–20 mm. It allowed to remove the big stones without crushing them with a safe and easy closure of the bladder wall thanks to the easy suturing provided by the Robot technology.

Comparison of the Safety and Efficacy of Laser Versus Pneumatic Intracorporeal Lithotripsy for Treatment of Bladder Stones in Children

“…No long-term complications were found in any of the treated patients in terms of urethral stricture or chronic lower urinary tract symptoms. Similar results were reported by most previous studies [9,10,15,17,19]. Abdul Rasheed and colleagues also reported a 3.5% rate of urethral stricture after pneumatic lithotripsy, which again might have been associated with the urethral dilation that was performed.…”

“…Later, the availability of pediatric cystoscopes and ureteroscopes, as well as highly effective intracorporeal lithotripsy devices with miniprobes, enabled the feasibility of transurethral CL in children [3,9,10,15]. Currently, pneumatic, laser and, to a lesser extent, electrohydraulic lithotripters are used to fragment stones in children [16].…”

“…Ho:YAG lasers enabled a major breakthrough in the management of stone disease in general. These lasers are safe and effective and can fragment many types of stones [10,17].…”

“…In 1994, Shokier reported the safe use of a pneumatic lithotripter to fragment bladder stones in children [9]. Subsequently, in 2005, Ramakrishnan et al used a laser (Ho:YAG) for the same purpose and reported the method to be safe and successful [10]. Since then, many studies have confirmed the safe and efficient use of both modalities in the treatment of pediatric bladder stones.…”

Giant Urinary Bladder Stone in a Middle-Aged Male

“…18 Robotic cystolithotomy has also been performed in this context, with promising results. 19 However, the preferred procedure for the treatment of giant calculi is still the cystolithotomy, as observed in this case.…”