Esposito Ciro, Autorino Giuseppe, Masieri Lorenzo, Castagnetti Marco, Del Conte Fulvia, Coppola Vincenzo, Cerulo Mariapina, Crocetto Felice, Escolino Maria
Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy.
Pediatric Urology Unit, Meyer Children Hospital, Florence, Italy.
Front Pediatr. 2021 Jan 26;8:618756. doi: 10.3389/fped.2020.618756. eCollection 2020.
Bladder stones (BS) are rare in children. Minimally invasive surgery (MIS) seems to be nowadays the procedure of choice to treat pediatric patients with BS. This study aimed to analyze retrospectively our experience with percutaneous cystolithotomy, endourological treatment with Holmium laser and robotic cystolithotomy in children with BS. We retrospectively analyzed the data of 13 children (eight boys and five girls) with BS who were treated at our centers between July 2013 and July 2020. The patients received three different MIS procedures for stones removal: five underwent robotic cystolithotomy, five underwent endourological treatment and three received percutaneous cystolithotomy (PCCL). We preferentially adopted endourological approach for stones <10 mm, percutaneous approach between 2014 and 2016 and robotic approach since 2016 for larger stones. Mean patients' age at the time of diagnosis was 13 years (range 5-18). Ten/13 patients (76.9%) had primary BS and 3/13 patients (23.1%) had secondary BS. Mean stone size was 18.8 mm (range 7-50). In all cases the stones were removed successfully. One Clavien II post-operative complication occurred following PCCL (33.3%). All the procedures were completed without conversions. Operative time ranged between 40 and 90 min (mean 66) with no significant difference between the three methods ( = 0.8). Indwelling bladder catheter duration was significantly longer after PCCL (mean 72 h) compared with robotic and endourological approaches (mean 15.6 h) ( = 0.001). Hospitalization was significantly longer after PCCL (mean 7.6 days) compared with the other two approaches (mean 4.7 days) ( = 0.001). The endourological approach was the most cost-effective method compared with the other two approaches ( = 0.001). Minimally invasive management of bladder stones in children was safe and effective. Endourological management was the most cost-effective method, allowing a shorter hospital stay compared with the other procedures but it was mainly indicated for smaller stones with a diameter < 10 mm. Based upon our preliminary results, robotic surgery seemed to be a feasible treatment option for BS larger than 15-20 mm. It allowed to remove the big stones without crushing them with a safe and easy closure of the bladder wall thanks to the easy suturing provided by the Robot technology.
膀胱结石（BS）在儿童中较为罕见。如今，微创手术（MIS）似乎是治疗儿童膀胱结石患者的首选方法。本研究旨在回顾性分析我们在儿童膀胱结石患者中进行经皮膀胱切开取石术、钬激光腔内治疗及机器人辅助膀胱切开取石术的经验。我们回顾性分析了2013年7月至2020年7月在我们中心接受治疗的13例膀胱结石患儿（8例男孩和5例女孩）的数据。患者接受了三种不同的微创手术取石：5例行机器人辅助膀胱切开取石术，5例行腔内治疗，3例行经皮膀胱切开取石术（PCCL）。对于直径<10mm的结石，我们优先采用腔内治疗方法；2014年至2016年对于较大结石采用经皮治疗方法，自2016年起对于更大结石采用机器人辅助治疗方法。诊断时患者的平均年龄为13岁（范围5 - 18岁）。13例患者中有10例（76.9%）为原发性膀胱结石，3例（23.1%）为继发性膀胱结石。平均结石大小为18.8mm（范围7 - 50mm）。所有病例结石均成功取出。PCCL术后发生1例Clavien II级术后并发症（33.3%）。所有手术均顺利完成，无中转情况。手术时间在40至90分钟之间（平均66分钟），三种方法之间无显著差异（P = 0.8）。与机器人辅助和腔内治疗方法相比，PCCL术后留置膀胱导尿管时间显著更长（平均72小时）（P = 0.001）。与其他两种方法相比，PCCL术后住院时间显著更长（平均7.6天）（P = 0.001）。与其他两种方法相比，腔内治疗方法是最具成本效益的方法（P = 0.001）。儿童膀胱结石的微创治疗安全有效。腔内治疗是最具成本效益的方法，可以比其他手术缩短住院时间，但主要适用于直径<10mm的较小结石。基于我们的初步结果，机器人手术似乎是治疗直径大于15 - 20mm膀胱结石的可行治疗选择。由于机器人技术提供的简便缝合，它能够在不粉碎结石的情况下取出大结石，并安全轻松地闭合膀胱壁。
