Minimally invasive percutaneous cystolithotomy: an effective treatment for bladder stones in infants aged <1 year

Abstract

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To present our experience with minimally invasive percutaneous cystolithotomy (MPCCL) for the treatment of bladder stones in infants aged <1 year. PATIENTS AND METHODS From 1 January 2003 to 31 October 2008, 15 boys with a mean (range) age of 8.2 (3.0–11.5) months underwent MPCCL. The mean (range) stone diameter was 1.4 (0.9–2.2) cm. Ten infants had a solitary stone while five had more than one stone. MPCCLs were performed under general anaesthesia. A 16 F peel‐away sheath was introduced as a working tract after dilatation with percutaneous nephrolithotomy dilators (8–16 F) under fluoroscopic control. After dilatation, an 8–9.8 F ureteroscope was introduced into the bladder, and the stones were fragmented with a shock wave lithotriptor. After the MPCCL, a 14 F suprapubic catheter was left in situ and fixed to the skin, and removed 1 or 2 days after MPCCL. The urethral catheter was removed 2 or 3 days after MPCCL. The absence of stone fragments on plain X‐ray/ultrasonography was considered as a ‘stone‐free’ status. RESULTS All infants were stone‐free after one MPCCL; no recurrent stones developed. The mean MPCCL procedure time was 25 min and intraoperative blood loss was scant. Perioperative complications were few. The mean hospital stay was 2.8 days. CONCLUSION MPCCL is a safe and effective treatment option for bladder stones in infants, reducing postoperative complications and shortening hospital stay.

A randomised trial comparing transurethral to percutaneous cystolithotripsy in boys

“…Multiple studies reported its use in normal paediatric bladders harbouring variable‐sized stones [3,25–27]. Also, it was performed safely in infants aged as young as 3 months [28]. Similar to our results, the commonly reported complications were persistent suprapubic fluid extravasation and intraperitoneal fluid collection [3,26].…”

Transurethral Holmium Laser Cystolithotripsy in Children: Single Center Experience

“…25 Isen et al, reported their experience with pneumatic CL in children with a mean age of 7.6yrs (range, 3 -14). The mean stone size was 14mm (range, [8][9][10][11][12][13][14][15][16][17][18][19][20]. The operating time was 22min (range, 10-46 min).…”

“…The final published version may differ from this proof. of 25min and mean hospital stay of 2.8 days 19. However, PCCL has important disadvantages, such as the presence of an incision, the need to dilate a tract, the insertion of a suprapubic tube, and the need for a urethral catheter which leads to relatively longer hospital stay when compared with CL.…”

Retrograde-Assisted Percutaneous Cystolitholapaxy Versus Transurethral Cystolithotripsy With Holmium-YAG Laser: A Retrospective Study

“…It is not mandatory to be an endourologist or a super professional urologist to do this method; furthermore, it does not need any unusual instruments and it can be done in every urology operating room even with limited facilities. 21,22…”