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Percutaneous vacuum vesicolithotomy under direct vision: a new technique
J G Van Savage1, A E Khoury, G A McLorie
1Department of Surgery, Hospital for Sick Children, University of Toronto, Ontario, Canada.
Insights
Percutaneous vacuum vesicolithotomy offers a safe and effective method for removing bladder stones (vesical calculi) in children. This minimally invasive technique avoids urethral trauma, making it ideal for patients with challenging urethral anatomies.
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.
Purpose:
The number of vesical calculi is increasing as the number of patients with intestinocystoplasty increases. We describe our technique for easily removing vesical calculi in children via an atraumatic percutaneous endoscopic approach.
Materials And Methods:
The procedure involves percutaneous suprapubic puncture and direct visualization of the calculi via cystoscopy through the urethra or via a second suprapubic puncture when the bladder neck is closed. The stones are vacuumed up 1 at a time with suction tubing through the suprapubic working sheath in a controlled manner with no urethral trauma. Ten patients 3 to 16 years old (mean age 8) with vesicolithiasis underwent percutaneous vacuum vesicolithotomy under direct vision in 1993 to 1995.
Results:
Two to 12 bladder calculi were extracted (mean 7). All calculi less than 1 cm. were removed by this procedure. All bladder calculi between 1 and 1.5 cm. were also removed but they required simultaneous electrohydraulic lithotripsy. There were no complications at a mean 1-year followup. Mean hospitalization was less than 24 hours (range 0 to 3 days).
Conclusions:
Percutaneous vacuum vesicolithotomy is highly successful, easy to perform and safe for extracting vesical calculi. Since the procedure is done through a percutaneous sheath, it is particularly suited to the individual with an absent, small caliber, sensitive or surgically reconstructed urethra.