Transurethral Holmium Laser Cystolithotripsy in Children: Single Center Experience

Area of Science:

• Pediatric Urology
• Endourology
• Laser Lithotripsy

Background:

• Bladder stones in children pose a significant health risk, particularly in developing nations.
• Open cystolithotomy has been the traditional treatment, but advancements in pediatric endoscopes facilitate a shift towards minimally invasive endourologic procedures.

Purpose of the Study:

• To prospectively evaluate the safety and efficacy of transurethral cystolithotripsy (CL) using the holmium:yttrium-aluminum-garnet (Ho:YAG) laser in pediatric patients.
• To establish Ho:YAG laser CL as a viable alternative to open surgery for pediatric bladder calculi.

Main Methods:

• A prospective study included 33 children under 12 years old with vesical calculi, excluding those with specific comorbidities or large stones (>4 cm).
• Transurethral cystolithotripsy was performed under general anesthesia using 9-11F cystoscopes with Ho:YAG laser fragmentation (30W) under video guidance.
• Exclusion criteria included orthopedic deformities, urethral stricture, prior urethral surgery, or bladder reconstruction.

Main Results:

• The study included 33 children with a median age of 3 years and mean stone size of 2.02 cm.
• The mean operative duration was 31.21 minutes, with all patients discharged within 24 hours after a single operative session.
• A 100% stone-free rate was observed at a mean follow-up of 16.87 months, with no reported complications, urethral strictures, or stone recurrence.

Conclusions:

• Holmium:YAG laser cystolithotripsy is a safe, effective, and minimally invasive treatment for pediatric bladder stones.
• The procedure demonstrates a high success rate (100%) with no significant complications or long-term adverse effects.
• This technique offers a promising alternative to open surgery for managing bladder stones in children.