Percutaneous cystolithotomy for pediatric endemic bladder stone: experience with 155 cases from 2 developing countries.

PURPOSE: The aim of this study was to evaluate retrospectively our experience with percutaneous cystolithotomy (PCCL) in children having endemic urinary bladder stones. METHODS: Between January 1993 and June 2003, 155 children younger than 14 years underwent PCCL. The patients' age ranged from 8 months to 14 years (average, 4.5 years). One hundred fifteen patients (74.2%) were 5 years or younger, 31 patients (20%) were between 6 and 10 years, and 9 patients (5.8%) were between 11 and 14 years. There were 153 boys and 2 girls. The stone size ranged from 0.7 to 4 (average, 2.3) cm. The procedure was done under general anesthesia. Dilation of the tract was made under fluoroscopy. The instrument was the adult 26F nephroscope, the same that is used for percutaneous nephrolithotomy. Ultrasound disintegration was needed for stones larger than 1 cm. Suprapubic catheter was left for 24 hours. Urethral catheter was kept for 48 hours. RESULTS: All patients became stone-free. The average operating time was 20 (5-60) minutes. The average hospital stay was 2.7 (2-5) days. No any severe intra- or postoperative complication was observed. The nucleus and/or the main component of the stones were ammonium acid urate in 144 patients (93%). CONCLUSIONS: Based on our experience, we can conclude that PCCL is a safe and effective method for treatment of endemic bladder stones in children. It reduces morbidity and hospital stay, and thus the cost of treatment. Our series proves the nutritional etiology of the endemic pediatric bladder stones.

Percutaneous nephrolithotomy in children: experience with 138 cases in a developing country.

Our aim was to evaluate our experience with percutaneous nephrolithotomy (PCNL) in children in the Republic of Yemen. Between January 1993 and December 1998, 135 children underwent 138 percutaneous nephrolithotomies in Yemen. The patient's age ranged between 8 months and 14 years (average 8.9 years). There were 117 boys and 18 girls (male:female ratio 6.5:1). The stone size ranged between 124 and 624 mm2 (average 507 mm2). A 26 F adult nephroscope was used. The stone free rate was 98.5% (136 out of the 138 cases). Two patients had clinically insignificant fragments. A second session had to be performed because of residual stone in one patient. No severe intra- or postoperative complications were observed. We conclude that percutaneous nephrolithotomy is a safe and effective method for the treatment of kidney stones in children. It reduces morbidity and hospital stay and thus the cost of treatment. To our knowledge, this is the largest reported series.

Endoscopic management of pediatric urolithiasis in a developing country.

OBJECTIVES: To evaluate our experience with the endoscopic management of lower and upper urinary tract stones in pediatric patients in the Republic of Yemen. METHODS: From January 1, 1993 to December 31, 1998, 290 endoscopic operations were performed on 265 pediatric patients up to 14 years of age, 173 on the upper and 117 on the lower urinary tract. Of these procedures, 138 were percutaneous nephrolithotomy, 5 were endopyelotomy combined with percutaneous nephrolithotomy, 30 were ureteral lithotripsy, and 117 were percutaneous cystolithotomy. Of the 265 patients, 244 were boys and 21 girls (male/female ratio 11.6:1, upper tract 7.4:1, lower tract 116:1) aged 8 months to 14 years (mean age 7.1 years). The 26F adult nephroscope and 9.5F semirigid ureteroscope were used. RESULTS: The overall success rate was 98.9%. Minor complications were observed in 29 patients (10.7%); severe complication did not occur. The nucleus and/or the main component of the stones was ammonium urate in 73.5% of the cases (upper tract 54%, but for those younger than 5 years, it was 75%; lower tract 93%). CONCLUSIONS: The endoscopic management of pediatric urolithiasis is a safe and effective method. To our knowledge, this is the largest reported series on the endoscopic management of pediatric urolithiasis.

Simultaneous bilateral compared with unilateral percutaneous nephrolithotomy.

OBJECTIVE: To compare simultaneous bilateral percutaneous nephrolithotomy (SBPCNL) and unilateral PCNL in separate sessions in patients with bilateral renal stones for several variables before and after surgery. PATIENTS AND METHODS: The results from SBPCNL carried out at two centres in different countries on 198 patients (aged 1.25-70 years) were compared with those from 300 patients undergoing unilateral PCNL in separate sessions. At one centre where extracorporeal shockwave lithotripsy (ESWL) was available SBPCNL was used for stones where at least two sessions of ESWL would have been required on each side. Other associated procedures were also used wherever required. RESULTS: The stones were cleared bilaterally in one session of SBPCNL in 190 patients; in eight, fragments of < 3 mm remained but were not clinically significant. A second session was required in six patients on one side only. Variables assessed before and after treatment (e.g. hospital stay, analgesia requirements and complications) were not significantly different between SBPCNL and PCNL. The mean (range) total operative duration for SBPCNL was 46 (20-100) min and the hospital stay 4.3 (3-8) days. CONCLUSION: From this experience, SBPCNL is a cost-effective and beneficial solution for selected patients, with clear advantages over separate unilateral PCNL in patients with bilateral stones.