Al-Marhoon Mohammed S, Sarhan Osama M, Awad Bassam A, Helmy Tamer, Ghali Ahmed, Dawaba Mohammed S
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
J Urol. 2009 Jun;181(6):2684-7; discussion 2687-8. doi: 10.1016/j.juro.2009.02.040. Epub 2009 Apr 16.
Vesical stones are common in children in developing countries. Cystolithotomy is the traditional treatment but a percutaneous approach has been advocated. The aim of this study was to evaluate retrospectively our experience with percutaneous cystolithotomy, cystolitholapaxy and open cystolithotomy in children with bladder stones.
A total of 107 children (96 boys and 11 girls) with vesical stones were treated at our center between January 1992 and March 2008. Mean patient age at the time of diagnosis was 5 years (range 2 to 15). The patients were stratified retrospectively into 2 groups according to the procedure of stone removal. Group 1 (53 patients) underwent open cystolithotomy, and group 2 (54) underwent endourological treatment via the transurethral route (27) or the suprapubic approach (27). Stone size ranged from 0.7 to 5 cm (mean 2.8).
In all cases the stones were removed successfully. Operative time was comparable in both groups. The hospital stay was significantly shorter after endourological procedures compared to open surgery (2.6 vs 4.8 days, p <0.05). In the open surgery group 1 patient had a small intestinal injury that necessitated repair, while in the endourological group 2 patients had urinary extravasation (1 urethral and 1 vesical). There were no early or late complications in group 1. In comparison, 4 patients (7.4%) in group 2 had early complications in the form of persistent urinary leakage from the suprapubic site and 1 patient had a bulbous urethral stricture 1 year after transurethral stone disintegration.
Open and endourological management of vesical stones in children is efficient, with a low incidence of complications. Endourological management offers a shorter hospital stay compared to open surgery. However, open cystolithotomy seems to be safer.
膀胱结石在发展中国家儿童中较为常见。膀胱切开取石术是传统的治疗方法，但也有人主张采用经皮途径。本研究的目的是回顾性评估我们对儿童膀胱结石行膀胱结石经皮取石术、膀胱碎石术和开放性膀胱切开取石术的经验。
1992年1月至2008年3月间，我们中心共治疗了107例膀胱结石患儿（96例男孩，11例女孩）。诊断时的平均年龄为5岁（范围2至15岁）。根据结石取出的手术方式，将患者回顾性地分为2组。第1组（53例患者）接受开放性膀胱切开取石术，第2组（54例）通过经尿道途径（27例）或耻骨上途径（27例）接受腔内泌尿外科治疗。结石大小为0.7至5厘米（平均2.8厘米）。
所有病例结石均成功取出。两组手术时间相当。与开放手术相比，腔内泌尿外科手术后住院时间明显缩短（2.6天对4.8天，p<0.05）。开放手术组有1例患者发生小肠损伤，需要修复，而腔内泌尿外科组有2例患者发生尿外渗（1例尿道和1例膀胱）。第1组无早期或晚期并发症。相比之下，第2组有4例患者（7.4%）出现早期并发症，表现为耻骨上部位持续漏尿，1例患者在经尿道结石粉碎术后1年出现球部尿道狭窄。
儿童膀胱结石的开放和腔内泌尿外科治疗均有效，并发症发生率低。与开放手术相比，腔内泌尿外科治疗住院时间更短。然而，开放性膀胱切开取石术似乎更安全。
