Percutaneous suprapubic cystolithotripsy approach: for whom? Why?

To evaluate the success and complications of percutaneous suprapubic cystolithotripsy (PCCL) in pediatric and adult patients with neurogenic bladder.

Between 2000 and 2004, 72 patients, all male (30 children aged 2 to 7 years [mean 4.7 years] and 42 spastic paraplegic adults aged 34 to 62 years [mean 53 years]), with sterile urine underwent PCCL under general anesthesia in one sitting. An 18-gauge needle, Amplatz dilatation set, 30F Amplatz sheath, rigid nephroscope, lithotripter (pneumatic, mechanic), and stone forceps were used. Fluoroscopy was not. A suprapubic catheter was placed in the first two patients only.

The dimensions of the stones were on average 3.2 cm (range 1-5 cm) for the pediatric patients and 5.5 cm (4-10 cm) for the adult patients. The operating time was 20 minutes (10-35 minutes). In all cases, the stones were taken out. No serious intraoperative or postoperative complications were observed. In all cases, the transurethral catheter was removed on postoperative day 5. No recurrence was observed during the follow-up period (mean 20 months).

As urethral diameters are narrow in pediatric patients and adult spastic paraplegic patients in whom an endoscopic approach could not be performed, PCCL is a safe alternative with low morbidity and complication rate. The technique is also more advantageous than open surgery with regard to cosmetic outcome and length of the hospital stay.