Percutaneous suprapubic cystolithotripsy for vesical calculi in children.

BACKGROUND: The majority of vesical calculi in adults can now be treated per-urethrally with the use of ultrasonic or pneumatic lithotripsy. However, the use of these devices is restricted in pediatric patients by the narrow caliber of the urethra. A percutaneous suprapubic approach to the bladder circumvents the problem of urethral caliber in these situations. PATIENTS AND METHODS: Thirty-eight children presenting with bladder stones underwent percutaneous suprapubic cystolithotripsy (PCCL) between November 1989 and April 1996. The age ranged from 1.5 to 7 years. The stone size ranged from 0.8 to 2.4 cm. Seven of these were recurrent stones, and five of the patients were female. The procedure was done under general anesthesia, and the equipment was the same as for upper tract endourology. The bladder was distended with saline and a suprapubic puncture made. The nephroscope was introduced after tract dilation and the stone removed, intact if small or after fragmentation if >1 cm. The procedure was done without fluoroscopy. A suprapubic catheter was left in for 48 hours. RESULTS: All patients had an uneventful recovery following stone removal. The average hospital stage was 3 days. Here, the access provided by percutaneous suprapubic cystostomy has been combined with the experience gained in upper-tract endourology to perform procedures that would otherwise require open operation because of nonavailability of urethral access. CONCLUSION: Extension of endourologic procedures to the lower tract reduces morbidity and hospital stay and thus the cost of treatment. Percutaneous suprapubic cystolithotripsy, in our experience, is a safe and cost-effective alternative to open surgery in children.     

Percutaneous suprapubic cystolithotripsy for pediatric bladder stones in a developing country

OBJECTIVE: To evaluate our experience with percutaneous suprapubic cystolithotripsy (PCCL) in Yemeni children with endemic urinary bladder stones. PATIENTS AND METHODS: Between January 1993 and December 1998, 117 children underwent percutaneous suprapubic lithotripsy in Arabia Felix Modern Hospital, Sana'a Republic of Yemen. The patients' ages ranged from 8 months to 14 years (average 3.7 years). Ninety patients (77%) were under 5 years old; 20 patients (16%) were between 6 and 10 years old, and 7 patients (6%) were between 11 and 14 years old. There were 116 boys and 1 girl. The stone size ranged from 0.7 to 4 (average 2.3) cm. Five patients had coexisting urinary bilharziasis and another 5 patients had coexisting renal stone. In 10 patients, the stone was in the urethra. The procedure was done under general anesthesia. Dilation of the tract was made under fluoroscopy. The instrument was an adult 26-french nephroscope, the same as that used for percutaneous nephrolithotripsy. Ultrasound disintegration was needed for stones of > 1 cm. A suprapubic catheter was left for 24 h, and a urethral catheter was kept for 48 h. RESULTS: All patients became stone free. The average operating time was 15 (5-50) min. The average hospital stay was 2.7 (2-5) days. No severe intra- or postoperative complication was observed. The nucleus and/or the main component of the stones were ammonium acid urate in 109 patients (93%). CONCLUSION: Based on our experience we can conclude that percutaneous suprapubic lithotripsy is a safe and effective method for the treatment of bladder stones in children. It reduces morbidity and hospital stay and thus the cost of treatment. Our series proves the nutritional etiology of endemic pediatric bladder stones. To our knowledge, this is the largest series reported on percutaneous suprapubic management of endemic bladder stones in children.     

Percutaneous treatment of calculi in reconstructed bladder

PURPOSE: To report our results with percutaneous removal of calculi from reconstructed bladders. PATIENTS AND METHODS: Twelve patients with reconstructed bladders who underwent endoscopic cystolithotomy were identified from our departmental database, and retrospective review of case notes and imaging was performed. RESULTS: Access was gained via an ultrasound-guided new tract in 9 patients (75%). An old suprapubic tract site was used in two patients, and the Mitrofanoff stoma was the route of access in one patient. The procedure was successful, with stone clearance achieved in all 12 cases. No major complications were observed. At a median follow up of 24 months, stone recurrence was observed in 5 patients (42%), 4 of whom underwent repeat procedures. Follow-up showed no change in continence in the patient with a Mitroffanoff stoma. CONCLUSION: Percutaneous cystolithotomy is a safe and effective minimally invasive option for removal of stones in a reconstructed bladder. We recommend endoscopic removal as the treatment of choice in these patients.     

Percutaneous versus transurethral cystolithotripsy and TURP for large prostates and large vesical calculi: Refinement of technique and updated data

Background and purpose: We compare two modalities of treatment; transurethral cystolithotripsy (TUCL) and percutaneous cystolithotripsy (PCCL), for large vesical calculi in patients who underwent simultaneous transurethral resection of prostate (TURP), and present refinements of the technique of PCCL. Patients and methods: Between July 1999 and June 2003, 54 patients were subjected to either TUCL (n = 19) or PCCL (n = 35) along with simultaneous TURP. Inclusion criteria were prostate volume > 50 ml, aggregate stone size > 3 cm with each individual stone > 1 cm, In the TUCL group, calculi were treated with 26F nephroscope, pneumatic lithotripsy and fragment extraction. This was followed by TURP with 26F continuous-flow resectoscope. In the PCCL group, calculi were removed through a suprapubic 30F Amplatz sheath followed by standard TURP with the suprapubic sheath in situ to provide continuous drainage. A 20F two-way Foley catheter was inserted suprapubically and urethrally in cases of PCCL and a 22–24F three-way catheter urethrally after TUCL. Results: The two groups were comparable in age. The mean prostate size as well as aggregate stone size was significantly larger in PCCL group. The operating time for stone removal was significantly less in the PCCL group while time required for TURP was statistically similar in two groups. In the TUCL arm three patients had residual stones requiring repeat TUCL, and one developed a urethral stricture.Conclusions: Combined TURP and PCCL is safe, more effective and a much faster alternative to combined TURP and TUCL in patients with large bladder calculi and large prostates.     

Evaluation of percutaneous suprapubic cystolithotripsy under local anesthesia

Objective  

To evaluate the feasibility and effectiveness of percutaneous cystolithotripsy under local anesthesia.     

经耻骨上膀胱造瘘途径治疗膀胱结石

目的：探讨经耻骨上膀胱造瘘途径治疗膀胱结石的方法。方法：经尿道插入膀胱镜或电切镜，行耻骨上膀胱造瘘，自造瘘通道插入气压弹道碎石冲击杆，内镜直视下行气压弹道碎石术，同时行经尿道前列腺电切术(TURP)者先碎石后再行TURP。结果：所有病例均一次碎石成功，碎石时间15—45min，未出现并发症，无结石残留。结论：该方法安全可靠，损伤轻微，操作方便，治疗费用低。     

TURP联合肾镜下弹道超声波碎石清石术治疗前列腺增生并发膀胱结石(附43例报告)

目的:探讨一期腔内治疗BPH并发膀胱结石的有效治疗方法.方法:采用TURP联合肾镜下气压弹道及超声碎石清石术治疗BPH并发膀胱结石43例.结果:43例均一次手术成功,无输血,无膀胱穿孔、TURP综合征及严重感染等并发症发生.术后复查KUB,膀胱内均未见结石残留,清石率达100%.住院5～7天.最大尿流率较术前明显改善.结论:TURP联合肾镜下气压弹道及超声碎石清石术治疗BPH并发膀胱结石,创伤小,恢复快,安全高效,是治疗BPH并发膀胱结石的理想方法.     

耻骨上小切口膀胱切开取石与经尿道钬激光碎石取石治疗大膀胱结石的疗效比较

目的 观察对比耻骨上小切口膀胱切开取石与经尿道钬激光碎石取石治疗大膀胱结石的临床效果.方法 选取2010年7月至2015年2月于本院诊治的合并良性前列腺增生的大膀胱结石患者共87例进行研究,随机原则分为研究组(n =45例)和对照组(n=42例),对照组实施经尿道钬激光碎石取石,研究组行耻骨上小切口膀胱切开取石治疗,均同期行TURP.比较两组术中出血量、总手术时间、取石时间、低体温、输血例数、住院时间、术后疼痛情况、治疗费用、术后并发症.结果 两组的出血量、住院时间、尿道狭窄发生率相比较无明显差异(P＞0.05);两组碎石取石时间、总手术时间对比,研究组均短于对照组(P＜0.05);研究组术中低体温发生率、治疗费用、术后泌尿系感染、结石残留发生率均较对照组更低(P＜0.05).结论 对临床中大膀胱结石患者采取耻骨上小切口膀胱切开取石治疗,手术时间短,结石残留率低,术后并发症少,效果显著,值得推广.     

B超引导经皮肾镜超声气压弹道碎石术治疗复杂性肾结石

目的：评价B超引导下经皮肾镜超声联合气压弹道碎石术治疗复杂性肾结石的临床疗效。方法：对2006年3月-2008年6月,采用B超引导下经皮肾镜超声联合气压弹道碎石术治疗90例96侧复杂性肾结石患者的手术时间、结石清除率、手术并发症等临床资料进行回顾性分析。结果：所有患者均成功建立F24皮肾通道并Ⅰ期碎石,平均手术时间70min,平均结石处理时间为50min。本组未出现气胸、肠道损伤等手术并发症。术后复查KUB平片,83例肾脏结石清除干净,净石率92％;7例肾脏有结石残留,辅助ESWL治愈。随访1～6个月,无严重手术并发症。结论：B超引导下经皮肾镜超声联合气压弹道碎石术处理复杂性肾结石具有高效、安全的特点,值得临床推广应用。