Management of Bladder Stones with Pneumatic Lithotripsy Using a Ureteroscope in Children

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

This study aimed to compare the safety and efficacy of laser lithotripsy and pneumatic lithotripsy, the two most commonly used transurethral lithotripsy methods for treating bladder stones in children in Iraq. Between January 2013 and December 2016, 64 children with bladder stones were included in this prospective randomized study, after ethical committee approval and written consent from the children’s parents or caregivers were obtained. Patients were assigned randomly by computer software to two groups treated with either pneumatic cystolithotripsy or laser lithotripsy. A 9 Fr. semirigid ureteroscope was used to pass the lithotripter through and fragment the stone. A catheter of 8–12 Fr. was then introduced and kept in place for 24 h. All children were hospitalized for 24 h, and the catheter was removed the next morning. Outpatient follow-up was maintained for 6–12 months. In terms of operation outcomes and complications, the laser lithotripsy group had a significantly longer duration of operation (74.5 ± 26.6 min vs. 51.5 ± 17.2 min, p = 0.001), whereas the number of patients requiring an extended hospital stay was significantly higher in the pneumatic lithotripsy group (48.5% vs. 16.1%, p = 0.006). Moreover, pneumatic lithotripsy was associated with a significantly greater risk of having at least one adverse effect (64% greater than that in the laser group). Stone clearance rates did not significantly differ between treatment groups. In conclusion, both pneumatic and laser lithotripters can be used to treat children with bladder stones with high efficacy and safety.

Giant Bladder Calculus in an Adult- A Persistent Problem in the Developing World: A Case Report

INTRODUCTION

Giant urinary bladder calculus in an adult is an uncommon entity. The number of patients with giant bladder calculi has decreased over recent years owing to wider availability of healthcare and better diagnostic modalities.

CASE REPORT

We present a case of a young adult without any history of recurrent urinary tract infections or bladder outlet obstruction with giant vesical calculus who presented to the emergency department with gross hematuria, abdominal pain, and dysuria. Investigations revealed a large calculus in the urinary bladder, and suprapubic cystolithotomy was performed. A large stone of 6.5×6×5.5 centimeters, weighing 125 grams, was removed. On follow-up, the patient was free of any symptoms and cystoscopy was normal.

CONCLUSION

Urinary outflow obstruction must be ruled out in all patients with giant vesical calculus. Patients without any predisposing condition should be treated as a separate entity and evaluated accordingly. Multiple surgical treatment modalities are available for bladder calculus patients. Treatment is personalised as per size of stone, number of stones, and associated comorbidities.

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

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.

Endemic bladder calculi in children

Urinary calculi are being recognized more frequently in children and the urinary bladder is the most common site for stone formation in the lower urinary tract. Bladder calculi are grouped into three basic categories: primary idiopathic/endemic, secondary, and migrant. The incidence of vesical calculi has declined significantly in the last 70 years in developed nations owing to improvements in nutrition and socioeconomic conditions, but it is still high in developing nations. Primary idiopathic/endemic bladder calculi typically occur in children, in the absence of urinary tract infection (UTI), urinary stasis, or foreign body, and diet lacking in animal proteins is the major contributor factor. Comprehensive preventive and treatment strategies are critical for improving the quality of life of diseased children, in addition to helping to eradicate, or at least decrease, the incidence of endemic bladder calculi in developing nations.

Pneumatic cystolithotripsy versus holmium:yag laser cystolithotripsy in the treatment of pediatric bladder stones: a prospective randomized study

PURPOSE

Holmium:yttrium-aluminum-garnet (Ho:YAG) laser and Pneumatic cystolithotripsy (CL) are the most widely practiced transurethral procedures for treatment of pediatric bladder stones. The aim of our study was to compare the safety and efficacy of Ho:YAG laser CL and pneumatic CL in the treatment of pediatric bladder stones.

METHODS

In this prospective randomized study from January 2012 to April 2015, 25 male children with bladder stones <3 cm were consecutively randomized into two treatment groups: group A (pneumatic CL) consisted of 13 patients and group B (Ho:YAG CL) consisted of 12 patients. Operative time, duration of stay and complications were recorded. Patients were followed up prospectively.

RESULTS

The mean operative time was significantly lower in group B (25.6 vs. 31.6 min) for stones <1.5 cm (p = 0.040). However, for stones between 1.5 and 3 cm in size, the mean operating times were similar in both the groups (49.4 min in Ho:YAG vs. 44.6 min in pneumatic, p = 0.40). There was no difference in complication rates and hospital stay in both the groups. No major complications were seen in both the groups.

CONCLUSIONS

We found that Ho:YAG CL was more effective than pneumatic CL for treating bladder stones smaller than 1.5 cm.

Cystoscopically guided percutaneous suprapubic cystolitholapaxy in children

PURPOSE

To evaluate the safety and efficacy of endoscopically guided percutaneous suprapubic artery forceps litholapaxy for pediatric vesical and posterior urethral stone <1 cm in diameter.

MATERIALS AND METHODS

A retrospective series study of 73 children (68 boys and 5 girls) with vesical and urethral stones less than 1 cm in diameter with an average age of 3.5 years (range 1-9 years) were included in this study. Cases with previous suprapubic surgery, stones of more than 1 cm in diameter, multiple bladder or urethral stone, anterior urethral stones and cases with neurological or anatomical abnormalities were excluded from our study. The bladder was filled and punctured suprapubically by an artery forceps under the vision of the pediatric cystoscopy then the stone is completely crushed. All intraoperative and postoperative complications were recorded. The stone-free rate status was evaluated 2 weeks postoperatively using plain X-ray/ultrasonography.

RESULTS

All cases were successful, and the stones were completely crushed to smaller insignificant fragments in a single session. No intraoperative bladder perforation or bleeding was recorded. The mean operative time was 12.5 min (ranging from 9 to 17 min). There were no postoperative complications apart from 2 cases of persistent suprapubic leakage postoperatively for 24 h and the leakage stopped after 48 h with the insertion of 8 Fr Foley catheter. In all cases, no significant stone fragments were found 2 weeks postoperatively.

CONCLUSION

Our technique for management of pediatric vesical and posterior urethral stone less than 1 cm is an easy and safe with no intraoperative or postoperative significant complications.

The management of bladder lithiasis in the modern era of endourology

The recent evolution in the management of vesical lithiasis is a result of the major advancements of modern endourology. The ideal method for achieving stone clearance, however, remains an issue of debate and evidence-based recommendations are lacking. Contemporary literature focuses on management options, such as extracorporeal shockwave lithotripsy, transurethral, percutaneous and minimally-invasive surgery, as well as state-of-the-art energy sources. Issues of particular interest include the results of comparative studies, the management of lithiasis in the paediatric population and the recent challenge of the traditional dogma that dictated BPH surgery for the management of vesical lithiasis secondary to bladder outlet obstruction.