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Endourological versus open cystolithotomy for bladder stone management among children: A systematic review and
Randy Fauzan1, Hendra Herman1, Wendy Rachman2
1Urology Division, Department of Surgery, School of Medicine, Raden Mattaher Hospital, Universitas Jambi, Jambi, Jambi, 36121, Indonesia.
Insights
Pediatric bladder stone treatment via endourology or open surgery shows similar stone-free rates and fewer complications. Open surgery is faster, but TUCL offers the shortest hospital stay for pediatric bladder stones.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Bladder Stone Management
Background:
- The optimal treatment for pediatric bladder stones is not definitively established.
- This study addresses the debate by comparing endourological and open surgical approaches.
Purpose of the Study:
- To compare the efficacy and safety of endourological versus open cystolithotomy for pediatric bladder stones.
- Key outcomes evaluated include stone-free rate, complications, procedure duration, and length of hospital stay.
Main Methods:
- A systematic search of Medline, Embase, Cochrane, and clinicaltrials.gov databases was conducted.
- Meta-analysis included five studies (436 participants) comparing transurethral cystolithotripsy (TUCL), percutaneous cystolithotomy (PCCL), and open cystolithotomy (CL).
- Study quality was assessed using Cochrane's Risk of Bias tool.
Main Results:
- No significant difference in stone-free rates was observed between TUCL, PCCL, and CL.
- Complication rates were similar across all surgical methods.
- Open cystolithotomy (CL) had the shortest procedure duration, while TUCL resulted in the shortest hospital stay.
Conclusions:
- Both endourological and open surgical methods provide comparable stone-free rates and low complication rates for pediatric bladder stones.
- Open surgery offers a shorter operative time, whereas TUCL demonstrates the shortest length of hospital stay.
- The choice of procedure should consider operative time and patient recovery (length of stay).
Abstract:
Background: The treatment of choice for bladder stones in children remains debatable. This study aimed to compare the outcomes of endourological and open cystolithotomy for the management of bladder stones in children. Methods: The Medline, Embase, Cochrane controlled trial databases and clinicaltrials.gov were searched for relevant English-language publications from 1 to 30 August 2022. Stone-free rate (SFR), complication rate, length of stay, and procedure duration were compared. Children (male and female) <18 years of age of any ethnicity with bladder stones (single/multiple) were included. Patients with a history of bladder augmentation or diversion were excluded. The quality of studies included was assessed using Cochrane's Risk of Bias Assessment. The meta-analysis was performed using RevMan. Results: Five articles (436 participants) that compared endourological versus open cystolithotomy were included in qualitative and quantitative analyses. Four were non-randomised, retrospective, and single centre studies. While the other one was a randomised controlled trial. Measure outcome characteristics included SFR, complications, procedure duration, and length of hospital stay. There was no significant difference in the SFR between transurethral cystolithotripsy (TUCL) and percutaneous cystolithotomy (PCCL) ( p=0.22). There were also no significant differences in complications (TUCL versus PCCL, p=0.18; TUCL versus open cystolithotomy [CL] and PCCL versus CL, p=0.08). PCCL featured a longer procedure duration than TUCL ( p<0.00001), while CL was shorter than TUCL and PCCL (both p<0.00001). Finally, in terms of length of stay, TUCL was superior to PCCL and CL, while PCCL was better than CL (all p<0.00001). Conclusions: Endourological and open surgical management of bladder stones in children showed comparable SFR and fewer complications. Open surgery offers a shorter procedure duration than endourological management, but PCCL features a shorter procedure duration than TUCL. In terms of length of stay, TUCL and PCCL were superior to CL, while TUCL was better than PCCL.
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