Management of bladder stones with pneumatic lithotripsy by using a ureteroscope in children

Purpose: To evaluate the effectiveness and safety of pneumatic lithotripsy by using a ureteroscope to treat bladder stones in children. Patients and Methods: Twenty-seven boys presenting with bladder stones underwent transurethral cystolithotripsy. The indication for transurethral cystolithotripsy was stone size <= 2 cm. A 8/9.8F Wolf semi-rigid ureteroscope or 9.5F Storz ureteroscope and a pneumatic lithotripter were used for stone fragmentation in all patients. Results: All patients were stone-free at 2 weeks postoperatively. The mean age was 7.6 years ( range 3-14 years), and the mean stone size was 14 mm ( range 8-20 mm). The operating time was 22 minutes ( range 10-46 minutes). The mean hospitalization time was 1.2 days ( range 1-3 days), and the mean follow-up was 13 months ( range 1-32 months). No complications due to pneumatic lithotripsy other than mild hematuria were observed intraoperatively. Stone forceps were used to retrieve large stone fragments ( 5-6 mm in size) in 10 ( 37%) of the patients. After the operation, acute retention was observed in 2 ( 7.4%) of the patients due to failure of fragments to pass through the urethra. A second procedure was performed on these patients. Fever was observed in 2 ( 7.4%) of patients. No long-term complications or stone recurrences were seen in any patient. Conclusion: Pneumatic lithotripsy using a ureteroscope appears to be an effective and safe treatment for bladder stones in children. It is minimally invasive and involves reduced hospital stay and overall cost. However, it can cause some problems in terms of spontaneous passage. Thus it may be used as an alternative treatment option in selected patients.