Lesnic O, Lemelle J L, Mourey E, Leclerc F, Schmitt M
Service de Chirurgie Infantile, Hôpital d'Enfants, CHU de Nancy, 54 511 Vandoeuvre les Nancy, France.
J Pediatr Urol. 2006 Dec;2(6):564-8. doi: 10.1016/j.jpurol.2006.01.008. Epub 2006 Mar 24.
Bladder-stone formation is a common problem following augmentation cystoplasty. Urological management is controversial. We describe a minimally invasive technique using electrohydraulic vesicolithotripsy via a single percutaneous access.
Between 1998 and 2004, 10 percutaneous extractions of bladder calculi were performed in seven patients with bladder augmentation. Prior bladder enlargement was performed for neuropathic bladder dysfunction in four cases and bladder exstrophy in three cases. The procedure involved percutaneous placement of a 10- or 12-mm laparoscopic trocar, after which the airtightness valve of the trocar was removed. A rigid nephroscope allowed direct visualization of calculi. Stones were fragmented with electrohydraulic lithotripsy when necessary. Removal of the fragments was by grasping forceps or basket. Vigorous, warmed-saline bladder irrigation eliminated residual fragments.
The technique was successful in all cases, resulting in controlled bladder-stone-free status and no surgical complications. The only complication was hypothermia linked to prolonged operation time, inadequate warmed-saline irrigation and lack of waterproof sheets.
Percutaneous vesicolithotripsy was highly successful and easy to perform, without being restricted by size and number of calculi. The continence mechanism of a reconstructed urethra or Mitrofanoff conduit should not be compromised. As recurrent stone formation is expected in children with augmented bladder, this technique appears to be suitable for bladder calculi removal during the long-term follow-up of multioperated patients.
膀胱扩大成形术后膀胱结石形成是一个常见问题。泌尿外科治疗存在争议。我们描述了一种通过单一经皮穿刺途径使用液电碎石术的微创技术。
1998年至2004年间，对7例膀胱扩大术患者进行了10次经皮膀胱结石取出术。4例因神经源性膀胱功能障碍、3例因膀胱外翻先行膀胱扩大术。手术包括经皮置入10或12毫米腹腔镜套管针，然后移除套管针的气密阀。使用硬性肾镜可直接观察结石。必要时用液电碎石术将结石击碎。用抓钳或网篮取出碎片。用温热的生理盐水大力冲洗膀胱以清除残留碎片。
该技术在所有病例中均成功，实现了膀胱结石清除且无手术并发症。唯一的并发症是与手术时间延长、温热生理盐水冲洗不足和缺乏防水床单相关的体温过低。
经皮膀胱碎石术非常成功且易于实施，不受结石大小和数量的限制。重建尿道或米氏可控膀胱造瘘管的控尿机制不应受到损害。由于膀胱扩大术患儿预计会复发结石形成，该技术似乎适用于多次手术患者的长期随访期间膀胱结石的清除。
