Cystolitholapaxy versus cystolithotomy in children

Primary vesical stones are common in children in developing countries. Cystolithotomy is the traditional treatment, but a percutaneous approach has been advocated.

Between January 1992 and March 1997, 52 male children with primary vesical stones were treated at our center. The patients were stratified retrospectively into two groups according to the procedure of stone removal. Group I (25 patients) were children who underwent open cystolithotomy, and group II (27 patients) were those who had endourologic treatment either by the transurethral route (11 children) or via suprapubic approached (16). The mean age at the time of diagnosis was 3.6 +/- 2.1 years. The stone size ranged from 0.7 to 2 cm (mean 1.2 +/- 0.7 cm).

In all cases, the stones were removed successfully. The operative time was similar in the two groups. The hospital stay was significantly less after endourologic procedures than after open surgery (P < 0.05). In Group I, one patient had a small-intestinal injury, and in Group II, one patient had urethral rupture and extravasation during transurethral cystolitholapaxy. There were no early or late complications in Group I. However, in Group II, 4 patients (15%) developed early and late complications. Early morbidity was in the form of persistent leakage of urine from the suprapubic site in one patient and acute abdomen from the peritoneal urine leakage in another two patients who had the same approach. A stricture of the bulbous urethra was seen in one patient 1 year after transurethral stone disintegration.

In spite of the improvement of endourologic instruments, open surgical removal of primary vesical stones in boys is still the mainstay of therapy.