BERKELEY, CA (UroToday.com) - Minimally invasive approaches to stone disease have become the mainstay of treatment when surgical intervention is necessary. Bladder stones have been historically treated by open cystolithotomy, but percutaneous access into the bladder is part of the surgical armamentarium in the pediatric population. This study by Salah et al retrospectively evaluated percutaneous cystolithotomy (PCCL) for urinary bladder stones in children.

Over a ten-year period, 155 children younger than 14 years underwent PCCL. The age of the patients ranged from 8 months to 14 years (average, 4.5 years). One hundred fifteen patients (74.2%) were 5 years or younger, 31 patients (20%) were between 6 and 10 years, and 9 patients (5.8%) were between 11 and 14 years. There were 153 boys and 2 girls. The stone size ranged from 0.7 to 4 (average, 2.3) cm. The procedure was done under general anesthesia. Dilation of the tract was made under fluoroscopy. An adult 26F nephroscope, the same that is used for percutaneous nephrolithotomy, was employed through the tract. Ultrasound disintegration was used for stones larger than 1 cm. They left a suprapubic catheter was for 24 hours and urethral catheter was left for 48 hours.

The group found that all patients became stone free with one intervention. The average operating time was 20 (5-60) minutes. The average hospital stay was 2.7 (2-5) days. There were no complications.

The group concluded that PCCL is a safe and effective method for treatment of bladder stones in children. It reduced morbidity and hospital stay in their study, and it can be extrapolated that this would decrease the cost of treatment. It has been my experience that adding a pneumatic component to the ultrasonic lithotripsy reduces the operative time for any large stone burden.

Journal of Pediatric Surgery 40(10): 1628-1631, October 2005