Percutaneous cystolithotomy in the pediatric neuropathic bladder with laparoscopic trocar access: a modified approach useful for the augmented and native bladder, and continent urinary reservoir.

OBJECTIVE

We present our results of percutaneous cystolithotomy with laparoscopic trocar (PCLT) access in children.

MATERIALS AND

METHODS

PCLT was performed in 13 cases. This includes 2 patients who had this performed twice for recurrent stone 12-24 months after initial surgery. Eight patients had a bladder augmentation, 2 had native bladders, and one a continent urinary reservoir. Nine patients had a reconstructed urethra. Cystoscopy was performed in all cases to assess stone burden. Under direct vision, an 18 gauge angiocatheter was placed into bladder and guidewire placed through the angiocatheter. With the bladder distended, a laparoscopic 10 mm trocar was placed under vision next to the guidewire. A 26Fr nephroscope was used via the trocar to extract the stones, utilizing laser or ultrasonic lithotripsy to fragment larger stones. Stone fragments were removed with graspers and/or the vacuum extraction technique.

RESULTS

PCLT was successful in all cases. No complications were noted. Six cases were treated as outpatient, seven discharged home after 12-23 h observation.

CONCLUSIONS

PCLT via laparoscopic trocar access is a facile and safe approach for removing stones in the pediatric neuropathic bladder. Advantages include the ability to distend the bladder with continuous flow and the larger working channel permitting use of the nephroscope to treat and extract stones.