Transurethral Cystolithotripsy vs Percutaneous Cystolithotomy for Bladder Stones in Children: A Systematic Review and...

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Nephrolithiasis Treatment

Background:

• Minimally invasive treatments for pediatric bladder stones (BS), including transurethral cystolithotripsy (TUCL) and percutaneous cystolithotomy (PCCL), are established as safe and effective.
• Uncertainty persists regarding the comparative surgical outcomes and potential complications between TUCL and PCCL for pediatric BS.
• A comprehensive understanding of long-term stone-free rates (SFR), postoperative complications, and cost-effectiveness is crucial for optimizing treatment selection.

Purpose of the Study:

• To conduct a meta-analysis comparing transurethral cystolithotripsy (TUCL) and percutaneous cystolithotomy (PCCL) for the treatment of bladder stones (BS) in pediatric patients.
• To evaluate and compare key outcomes including long-term stone-free rates (SFR), postoperative complications, operative time, hospital stay, and cost-effectiveness.
• To provide evidence-based insights to guide the selection of the optimal surgical approach for pediatric bladder stones.

Main Methods:

• A systematic meta-analysis was performed, searching PubMed, Embase, Cochrane Library, and Web of Science up to September 12, 2023.
• Studies evaluating SFR, operation time, hospital stay, and complications in pediatric patients undergoing TUCL or PCCL for bladder stones were included.
• Study quality was assessed using Cochrane tools and the Newcastle-Ottawa Scale system.

Main Results:

• Seven studies encompassing 397 pediatric patients (202 TUCL, 195 PCCL) met the inclusion criteria.
• Percutaneous cystolithotomy (PCCL) demonstrated significantly shorter operative times compared to transurethral cystolithotripsy (TUCL) (p < 0.00001).
• Transurethral cystolithotripsy (TUCL) was associated with significantly shorter hospitalization days than PCCL (p < 0.00001); other perioperative outcomes showed no significant differences.

Conclusions:

• Both transurethral cystolithotripsy (TUCL) and percutaneous cystolithotomy (PCCL) are effective and safe treatment options for pediatric bladder stones (BS).
• The choice between TUCL and PCCL may depend on balancing operative time against hospital stay duration.
• Further multicenter, large-patient series, and prospective studies are warranted to establish definitive guidelines, particularly regarding the critical stone size for surgical approach selection.