Percutaneous vacuum vesicolithotomy under direct vision: a new technique

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Endourology

Background:

• The incidence of bladder stones (vesical calculi) is rising, particularly in pediatric patients who have undergone intestinocystoplasty.
• Existing methods for stone removal may pose risks, especially in children with compromised urethral anatomy.

Purpose of the Study:

• To describe an atraumatic percutaneous endoscopic technique for the removal of vesical calculi in children.
• To evaluate the safety and efficacy of percutaneous vacuum vesicolithotomy.

Main Methods:

• The procedure involves percutaneous suprapubic puncture for direct visualization and stone removal using suction tubing through a working sheath.
• Cystoscopy via the urethra or a secondary suprapubic puncture was used for visualization.
• Ten pediatric patients (ages 3-16) with vesicolithiasis underwent the procedure between 1993 and 1995.

Main Results:

• A mean of 7 bladder calculi (range 2-12) were successfully extracted per patient.
• Stones less than 1 cm were removed completely; larger stones (1-1.5 cm) required adjunctive electrohydraulic lithotripsy.
• No complications were observed at a mean 1-year follow-up, with a mean hospitalization of less than 24 hours.

Conclusions:

• Percutaneous vacuum vesicolithotomy is a highly successful, straightforward, and safe method for extracting vesical calculi in children.
• This technique is particularly advantageous for patients with absent, narrow, sensitive, or surgically altered urethras, minimizing urethral trauma.