Percutaneous Cystolitholapaxy and Open Cystolithotomy in Exstrophy-Epispadias Complex: A Comparative Approach to...

Area of Science:

• Urology
• Minimally Invasive Surgery
• Pediatric Surgery

Background:

• Patients with exstrophy-epispadias complex (EEC) often have weakened fascia, complicating bladder stone management.
• A direct comparison of percutaneous cystolitholapaxy and open cystolithotomy outcomes in EEC patients is lacking.

Purpose of the Study:

• To evaluate and compare the therapeutic efficacy and morbidity of percutaneous cystolitholapaxy versus open cystolithotomy for bladder stones in EEC patients.
• To identify the optimal surgical approach for managing bladder stones in this unique patient population.

Main Methods:

• Retrospective review of 66 EEC patients undergoing their first percutaneous cystolitholapaxy or open cystolithotomy (2003-2023).
• Data collected included operative time, hospital stay, stone volume, stone-free rates, recurrence, and postoperative complications.
• Patients were analyzed based on whether augmentation was performed alongside the primary procedure.

Main Results:

• Percutaneous cystolitholapaxy demonstrated significantly shorter operative times (123-131 min) and hospital stays (1-1.5 days) compared to open cystolithotomy (196-218 min, 3 days) (p=0.0002 and p=0.0044, respectively).
• Both approaches achieved 100% stone-free rates, with no significant difference in stone recurrence (p=0.20).
• Open cystolithotomy had a higher incidence of postoperative vesicocutaneous fistulas (45.45% without augmentation) compared to percutaneous methods (p=0.0002).

Conclusions:

• Percutaneous cystolitholapaxy offers significant advantages in managing bladder stones in EEC patients, including reduced operative time and hospital stay.
• The percutaneous approach is associated with a lower risk of complications, particularly vesicocutaneous fistulas, compared to open surgery.
• Percutaneous cystolitholapaxy represents a safer and more efficient alternative for bladder stone treatment in the exstrophy-epispadias complex population.