Gnech Michele, Rotondi Giulia, Minoli Dario Guido, De Marco Erika Adalgisa, Mitzman Francesca, Silvani Carlo, Zanetti Stefano Paolo, Manzoni Gianantonio, Montanari Emanuele, Berrettini Alfredo
Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Pediatric Surgery Department, IRCCS G. Gaslini, Genoa, Italy.
J Pediatr Urol. 2025 Aug;21(4):855-861. doi: 10.1016/j.jpurol.2024.12.023. Epub 2025 Jan 2.
Bladder stones (BS) in children are a rare condition and represent 1-5 % of all urinary tract stones. With advances in miniaturized endoscopes and intracorporeal lithotripters, percutaneous cystolithotomy has been demonstrated to be an effective, safe and quick technique, despite the longer operative time. This limitation may be overcome by a semi-closed-circuit vacuum-assisted technology (vamPCL), characterized by a continuous inflow and a suction-controlled outflow (ClearPetra®).
To assess the safety and efficacy of a vamPCL characterized by continuous inflow and suction-controlled outflow to treat bladder stones in pediatric patients with native or augmented bladder.
From January 2021 up to December 2023, we prospectively collected variables on consecutive vamPCL procedures (Fig.) The stone-free rate (SFR) was defined as absence of stones or residual fragment <5 mm diagnosed with ultrasound.
Six patients with a median age of 139 months (55-212) were recruited for the study. Three patients (50 %) with the initial diagnosis of extrophy-epispadia complex had an augmented bladder, whereas of the remaining three (50 %) with an initial diagnosis of anorectal malformation two had an augmented bladder. All patients had a Mitrofanoff conduit opening on the right flank, except for one (16 %) with umbilical access. The mean cumulative stone size was 24 mm ± 14,2. The mean operating time was 78,3 min ± 14,7. One procedure was interrupted after 90 min due to the overall size (>50 mm). Stone removal was achieved only via suction in all cases. All vamPCL procedures were completed without intraoperative complications. Fever for 24 h (1/6; 16 %) was the only post-operative complication. The mean stay of the suprapubic catheter was 3.4 days ± 1,5 and of the trans-Mitrofanoff catheter was 9.3 days ± 4,5. The SFR was confirmed in all the cases with US performed after 2 months. Only one male patient (16 %) had recurrent stones after 8 months and he is waiting for second surgery. Mean follow-up was 7.2 months ± 9,4.
In the present study we demonstrated that vamPCL is safe and feasible in selected cases especially in those with augmented bladder. To our knowledge, this manuscript is the first to present the use of the ClearPetra® for the treatment of bladder stones.
To our knowledge, this manuscript is the first to present the use of the ClearPetra® for the treatment of bladder stones. The vamPCL seems to be sustainable, safe and feasible for bladder stones treatment in selected children.
儿童膀胱结石（BS）是一种罕见病症，占所有尿路结石的1%-5%。随着小型化内窥镜和体内碎石器的发展，经皮膀胱切开取石术已被证明是一种有效、安全且快速的技术，尽管手术时间较长。这种局限性可通过半封闭回路真空辅助技术（vamPCL）克服，其特点是持续流入和吸力控制流出（ClearPetra®）。
评估以持续流入和吸力控制流出为特征的vamPCL治疗天然膀胱或扩大膀胱的儿科患者膀胱结石的安全性和有效性。
从2021年1月至2023年12月，我们前瞻性收集了连续vamPCL手术的变量（图）。结石清除率（SFR）定义为超声诊断无结石或残留碎片<5mm。
6名中位年龄为139个月（55-212个月）的患者被纳入研究。3名初始诊断为膀胱外翻-尿道上裂综合征的患者（50%）有扩大膀胱，而其余3名初始诊断为肛门直肠畸形的患者（50%）中有2名有扩大膀胱。除1名（16%）经脐部入路的患者外，所有患者的Mitrofanoff导管开口均在右侧腹部。结石平均累积大小为24mm±14.2。平均手术时间为78.3分钟±14.7分钟。1例手术在90分钟后因结石总体积（>50mm）而中断。所有病例均仅通过吸力实现结石清除。所有vamPCL手术均无术中并发症完成。术后唯一并发症为24小时发热（1/6；16%）。耻骨上导管平均留置时间为3.4天±1.5天，经Mitrofanoff导管平均留置时间为9.3天±4.5天。2个月后行超声检查，所有病例均确认结石清除率。仅1名男性患者（16%）在8个月后复发结石，他正在等待二次手术。平均随访时间为7.2个月±9.4个月。
在本研究中，我们证明vamPCL在选定病例中是安全可行的，尤其是在那些有扩大膀胱的病例中。据我们所知，本手稿是首次介绍使用ClearPetra®治疗膀胱结石。
据我们所知，本手稿是首次介绍使用ClearPetra®治疗膀胱结石。vamPCL似乎对选定儿童的膀胱结石治疗具有可持续性、安全性和可行性。
