Percutaneous treatment of bladder stones in children: 10 years experience, is blind access safe?

PURPOSE: Bladder stones are more commonly found in children from developing countries. Open cystolithotomy or transurethral cystolithalopaxy are the traditional treatments but a percutaneous approach has been advocated. We present our experience with percutaneous cystolithotomy in children with bladder stones without any ultrasonic or fluoroscopic guidance.

MATERIALS AND METHOD: From April 2001 to October 2011, a total of 147 children (135 boys and 12 girls) with a mean (range) age of 4.07 (1-12.5) years underwent percutaneous cystolithotripsy (PCCL). The mean (range) stone diameter was 2.74 (0.8-5) cm. 138 children (94 %) had a solitary stone while nine (6 %) had more than one stone. The main component of the stones was calcium oxalate in 70 patients (48.6 %).

RESULTS: All children were stone-free after one PCCL; no recurrent stones developed. The mean (range) PCCL procedure time was 29.6 (12 to 48) min and intraoperative blood loss was scant. Perioperative complications were few. The mean (range) hospital stay was 1.2 (1-3) days.

CONCLUSIONS: Blind access PCCL (without any ultrasonic or fluoroscopic guidance) is a facile and safe approach for removing stones in the pediatric bladder stones. Advantages include the lack of ionizing radiation, no need for opacification by iodine contrast media and low relative cost. We recommend this minimally invasive technique for management of large bladder stones (larger than 1 cm) in children. To our knowledge, this is the largest single-center series reported on percutaneous cystolithotripsy of endemic bladder stones in children.