Surgical Management of Vesical Stones in Children: A Comparison Between Open Cystolithotomy, Percutaneous Cystolithotomy and Transurethral Cystolithotripsy With Holmium-YAG Laser

Abstract

Introduction: Bladder stone is more common in developing countries and it is one of the rare diseases affecting children. In recent years, there is an increasing tendency in urologists to have minimal invasive approaches. The aim of this study was to compare the results of surgical bladder stone management in our single tertiary center. Methods: From 159 children younger than 18 years with vesical stones treated during January 2000 to January 2015 in Shohada-e-Tajrish hospital, Tehran, Iran, 146 subjects entered to the study. According to type of intervention, patients stratified to three groups. First group included 80 patients that open cystolithotomy (OCL) was done for them, second group was 39 patients who underwent percutaneous cystolithotomy (PCCL) and third group was 27 patients who treated by transurethral cystolithotripsy with holmium-YAG laser (TULL). Demographic data, hospital stay, operation time, and post operation complications were recorded and comparison were drawn between the three groups. Results: Mean age was 8.3 ± 5.1 years (8.6 ± 5.1, 6 ± 4.2 years for boys and girls, respectively). Mean stone size (MSS) was 2.76 ± 1.07 cm and no significant differences were found between the three groups but it was larger in OCL group. Mean operative time (MOT) was 29.15 ± 7.12 minutes in separate; MOT in TULL was significantly higher than PCCL and OCL respectively (36.3 ± 5.97, 30.54 ± 5.27 and 26.06 ± 6.32 minutes/P = 0.000). Mean hospital stay (MHS) in OCL group was 3.55 ± 1 days that was higher than PCCL and TULL groups significantly (P = 0.000). Conclusion: Based on our study, holmium:YAG lithotripsy has a high success rate, and is a minimally invasive management, therefore it is a safe method for children bladder calculi treatment if proper equipment was available and done by expert hands.

Pneumatic Lithotripsy Versus Laser Lithotripsy for Ureteral Stones

“…Treating patients with urolithiasis is a part of daily urological practice 1,2 and there are different treatment methods for ureteral calculi such as open stone surgery, extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy, laparoscopic ureterolithotomy, and ureteroscopic procedures. 3 In the early 1980s open surgery was the best treatment for ureteral stones; but introducing the small caliber ureteroscope and ESWL resulted in the virtually extinction of open surgery.…”

Comparison of Stone Retrieval Basket, Stone Cone and Holmium Laser: Which One Is Better in Retropulsion and Stone-Free Status for Patients with Upper Ureteral Calculi?

“…[22][23][24] Endoscopic laser lithotripsy (LL) is frequently used to manage patients with urolithiasis. 8,25 A number of lasers have been used for LL, of which the Ho:YAG has become one of the most frequently used one. 26 The advantages of the Ho:YAG lithotripter are as follows: it can pass through a rigid or flexible ureteroscope 27 ; all types of stones with varying compositions can be fragmented 28 ; and the probability of stone migration is lower.…”

Experience of 138 Transurethral Urethrotomy With Holmium:YAG Laser

“…However, endoscopic techniques are performed more commonly than urethroplasty. 12 Today, Ho: YAG lasers broadly used in urological surgery include urolithiasis, [13][14][15] benign prostatic hyperplasia, 16 urinary tract strictures, 17 bladder malignancies or lesions of the external genitalia. 10,18 IU is a kind of transurethral intervention in which the stricture is incised by cold-knife or thermal energy incision.…”