Abstract
Background: Bladder stones (BS) are rare in children. Minimally invasive surgery (MIS) seems to be nowadays the procedure of choice to treat pediatric patients with BS. This study aimed to analyze retrospectively our experience with percutaneous cystolithotomy, endourological treatment with Holmium laser and robotic cystolithotomy in children with BS.Methods: We retrospectively analyzed the data of 13 children (eight boys and five girls) with BS who were treated at our centers between July 2013 and July 2020. The patients received three different MIS procedures for stones removal: five underwent robotic cystolithotomy, five underwent endourological treatment and three received percutaneous cystolithotomy (PCCL). We preferentially adopted endourological approach for stones <10 mm, percutaneous approach between 2014 and 2016 and robotic approach since 2016 for larger stones.Results: Mean patients' age at the time of diagnosis was 13 years (range 5–18). Ten/13 patients (76.9%) had primary BS and 3/13 patients (23.1%) had secondary BS. Mean stone size was 18.8 mm (range 7–50). In all cases the stones were removed successfully. One Clavien II post-operative complication occurred following PCCL (33.3%). All the procedures were completed without conversions. Operative time ranged between 40 and 90 min (mean 66) with no significant difference between the three methods (p = 0.8). Indwelling bladder catheter duration was significantly longer after PCCL (mean 72 h) compared with robotic and endourological approaches (mean 15.6 h) (p = 0.001). Hospitalization was significantly longer after PCCL (mean 7.6 days) compared with the other two approaches (mean 4.7 days) (p = 0.001). The endourological approach was the most cost-effective method compared with the other two approaches (p = 0.001).Conclusions: Minimally invasive management of bladder stones in children was safe and effective. Endourological management was the most cost-effective method, allowing a shorter hospital stay compared with the other procedures but it was mainly indicated for smaller stones with a diameter < 10 mm. Based upon our preliminary results, robotic surgery seemed to be a feasible treatment option for BS larger than 15–20 mm. It allowed to remove the big stones without crushing them with a safe and easy closure of the bladder wall thanks to the easy suturing provided by the Robot technology.
Highlights
Urolithiasis in childhood is rare in the developed world, and bladder stones (BS) represent 1 to 5% of all urinary tract stones [1,2,3,4]
The BS were secondary to foreign body reaction due to the bulking agent particles migrated into the bladder
As we already reported in laparoscopic surgery [32], we found that the intestinal preparation was helpful in robotics, especially in children weighing
Summary
Urolithiasis in childhood is rare in the developed world, and bladder stones (BS) represent 1 to 5% of all urinary tract stones [1,2,3,4]. The adoption of this approach in the pediatric patients is limited by the narrow caliber of the urethra in children [11]. For this reason, percutaneous techniques using nephroscope or operative optic were developed, with the aim to remove bladder stones quickly in large fragments [12,13,14,15]. With the increasing use of percutaneous techniques, an alternative solution to remove BS in children could be performing a percutaneous suprapubic bladder stone removal [16]. Percutaneous cystolithotomy (PCCL) has been demonstrated to be adequate, safe and quick to perform in managing BS in children [13, 14]. This study aimed to analyze retrospectively our experience with percutaneous cystolithotomy, endourological treatment with Holmium laser and robotic cystolithotomy in children with BS
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