Comparison between transurethral holmium :YAG laser cystolithotripsy and percutaneous suprapubic cystolithotomy in the management of bladder stones in children

ABSTRACT

Vesical stones in children are common in developing countries. Historically, open cystolithotomy has been the treatment of choice in the management of bladder calculi. Recently there are different treatmrnt of vesical stones like Transurethral Holmium laser cystolithotripsy and Percutaneous cystolithotripsy. To Compare between transurethral Holmium YAG laser cystolithotripsy and percutaneous suprapubic cystolithotomy in the management of bladder stones in children. A total of 33 children [31 boys and 2 girls] with vesical stones were treated at Urology Department of Al-Sadder Medical City in Najaf between January 2013 and June 2014. Mean patient age at the time of diagnosis was 4.2 years [range 8 months to 10 years]. The patients were divided into 2 groups according to the procedure of stone removal. Group 1 [15 patients] underwent percutanous suprapubic cystolithotomy and group 2 [18 patients] underwent transurethral Holmium YAG laser cystolithotripsy. Stone size ranged from 7 to 25 mm [mean 16.2mm]. Operative time ranged from 10 to 25 minutes [mean 18 minutes] in percutanous suprapubic cystolithotomy [group 1] and was ranged from 15 to 70 minutes [mean 30 minutes] in transurethral Holmium YAG laser cystolithotripsy [group 2]. The day of catheter removal was 24 to 96 hours [mean 36 hours] in group 1, while it range 0 to 48 hours [mean 8 hours] in group 2. The hospital stay was shorter after transurethral Holmium YAG laser compared to percutanous suprapubic cystolithotomy [30 vs. 72 hours]. No significant intraoperative or postoperative complication was encountered except prolong urinary leak in two patients [13.3] in group 1 and transient mild haematuria in three children [16.6%] and low grade fever in two children [11%] in group 2. In all cases [100%] the stones were removed successfully in first session in group 1 while one patient [5.5%] need second session due to residual small stone in group 2. Transurethral Holmium YAG laser and percutanous suprapubic cystolithotomy management of vesical stones in children are efficient, with a low incidence of complications. Transurethral Holmium YAG laser offers a shorter hospital stay and urethral catheterization but longer operative time compared to percutanous suprapubic cystolithotomy