Cystoscopically guided percutaneous suprapubic cystolitholapaxy in children
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.