Percutaneous vacuum vesicolithotomy under direct vision: a new technique.

PURPOSE

The number of vesical calculi is increasing as the number of patients with intestinocystoplasty increases. We describe our technique for easily removing vesical calculi in children via an atraumatic percutaneous endoscopic approach.

MATERIALS AND METHODS

The procedure involves percutaneous suprapubic puncture and direct visualization of the calculi via cystoscopy through the urethra or via a second suprapubic puncture when the bladder neck is closed. The stones are vacuumed up 1 at a time with suction tubing through the suprapubic working sheath in a controlled manner with no urethral trauma. Ten patients 3 to 16 years old (mean age 8) with vesicolithiasis underwent percutaneous vacuum vesicolithotomy under direct vision in 1993 to 1995.

RESULTS

Two to 12 bladder calculi were extracted (mean 7). All calculi less than 1 cm. were removed by this procedure. All bladder calculi between 1 and 1.5 cm. were also removed but they required simultaneous electrohydraulic lithotripsy. There were no complications at a mean 1-year followup. Mean hospitalization was less than 24 hours (range 0 to 3 days).

CONCLUSIONS

Percutaneous vacuum vesicolithotomy is highly successful, easy to perform and safe for extracting vesical calculi. Since the procedure is done through a percutaneous sheath, it is particularly suited to the individual with an absent, small caliber, sensitive or surgically reconstructed urethra.