Abstract
Background: This study is performed to find the outcome of transurethral fragmentation and clearance of bladder stones in children as well as assessment of stone recurrence after the procedure. Methods: It was a retrospective analysis of the medical record of 365 patients with bladder stones, treated with transurethral fragmentation at the Department of Pediatric Urology, The Children’s Hospital and the Institute of Child Health, Lahore, over a period of 5 years. Bladder stones were fragmented by using ureterorenoscope (URS) and pneumatic Lithotripsy under general anesthesia. Patients were asked to void next day for spontaneous passage of stone fragments. Duration of procedure, hospital stay, peroperative, and postoperative complications were recorded on a self-structured proforma. The collected data was analyzed with SPSS, version 22. Results: The mean age of the patients was 4.7 ±2.31 years, and male to female ratio was 6:1. Clinical presentation was painful micturition with milking of penis (55%), followed by straining during micturition (17.5%), urinary retention (10%), increased frequency of urine (8%), febrile UTI (7.5%), and hematuria (2%). The mean stone size on ultrasound was 17.2 ±3.8 mm (Range 7-25 mm). The average operating time was 18 minutes (Range: 12-35 minutes). The transurethral fragmentation was successfully done in all (100%) patients. Average hospital stay was 24 hours. Most patients (98.5%) passed all stone fragments in urine & were stone free at one week, confirmed by ultrasound and X-Ray Kidney, Ureter, and Bladder (KUB). Postoperative minor complications were found in (6%) patients including hematuria (3%), dysuria (2%), febrile UTI (1%), failure to void (0.5%). Stone recurrence was 0.27% and no urethral stricture was noted up to one year follow up. Conclusion: Endoscopic treatment of bladder stone in children appears effective and safe by fragmenting the stone into multiple small pieces, which passed out spontaneously without any need for extraction of stone. The associated complications and recurrence rate are very negligible.
Highlights
Bladder stones in children is evident from archeological discoveries, and the historical reports show that 2-3 % of children can develop urinary calculi.[1]
Bladder stone in children can be treated by open surgery to percutaneous cystolithotomy (PCCL) or per urethral cystolithotripsy (PUCL)
Percutaneous cystolithotomy is a safe and effective alternative for the treatment of bladder stones in children. [12, 13] this modality has have some benefits over conventional open cystolithotomy, but requires prolonged postoperative catheterization, with added risk of wound infection or fistula formation due to suprapubic incision
Summary
Bladder stones in children is evident from archeological discoveries, and the historical reports show that 2-3 % of children can develop urinary calculi.[1] in nations where stone disease is endemic, urolithiasis remains a serious problem accounting 4-8% cases of end-stage renal disease during the childhood.[2] High prevalence of bladder stones has been reported in Europe and North America in 18th and 19th centuries.[3] This trend later on shifted to East, stretching in a broad stone belt from Egypt through Iran, Pakistan, India and Thailand to Indonesia.[4] The prevalence of pediatric urolithiasis ranges from 5-15% in our part of world as compared to 1-5% in developed countries. Urinary bladder stone contributes about 50% of pediatric urolithiasis.[5]. This study is performed to find the outcome of transurethral fragmentation and clearance of bladder stones in children as well as assessment of stone recurrence after the procedure
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