Catheterless and drainless open suprapubic cystolithotomy in children: a safe procedure

The objective of this study is to compare the outcome of the children with vesical stones undergoing conventional open suprapubic cystolithotomy with those undergoing catheterless and drainless suprapubic cystolithotomy. The study included 176 children aged 1-15 years with bladder stones. It was a prospective study stretching over 14 years (1991-2003). In the initial years (1991-1994), 40 patients were used to put a urethral catheter for 5 days and retropubic drain for 48 h post-operatively, as has been recommended conventionally. From 1995 onwards we resorted to a catheterless-drainless (no suprapubic drain) suprapubic cystolithotomy in children with bladder stones. In all the patients, two-layered closure of bladder with absorbable sutures was done. The results of both protocols with regards to duration of hospitilisation and complications were compared. We observed that if the bladder is closed meticulously in two layers and complete haemostasis is achieved, bladder drainage by means of a catheter and drainage of retropubic space is not required. This approach allowed an early post-operative recovery without increasing the risks of complications. However, the catheterisation was required for patients with infected urine, recurrent stones and those operated earlier for ano-rectal malformations. The authors feel that for vesical stones, the catheterless-drainless suprapubic cystolithotomy in children is a safe procedure barring a few above-stated situations. The advantages of this procedure are a shorter hospital stay, early mobility and decreased morbidity.