Minimally Invasive Management of Bladder Stones in Children

Background: 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.
Methods: 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 <10mm, percutaneous approach between 2014 and 2016 and
robotic approach since 2016 for larger stones.
Results: 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 18.8mm (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 90min (mean 66) with no significant difference between the three methods (p = 0.8).
Indwelling bladder catheter duration was significantly longer after PCCL (mean 72 h)
compared with robotic and endourological approaches (mean 15.6 h) (p = 0.001).
Hospitalization was significantly longer after PCCL (mean 7.6 days) compared with the
other two approaches (mean 4.7 days) (p = 0.001). The endourological approach was
the most cost-effective method compared with the other two approaches (p = 0.001).
Conclusions: Minimally invasive management of bladder stones in children was safe
and effective. Endourological management was the most cost-effectivemethod, allowing
a shorter hospital stay compared with the other procedures but it was mainly indicated
for smaller stones with a diameter < 10mm. Based upon our preliminary results, robotic
surgery seemed to be a feasible treatment option for BS larger than 15–20mm. 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.