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Surgical Management of Vesical Stones in Children: A Comparison Between Open cystolithotomy, Percutaneous Cystolithotomy and Transurethral Cystolithotripsy with Holmium-YAG Laser

Babak Javanmard, Morteza Fallah Karkan, Mohammadreza Razzaghi, Saleh Ghiasy, Arash Ranjbar, Amirhossein Rahavian




Introduction: Bladder stone in children is rare but is more common in developing countries. In recent years, the urologists have trend to minimal invasive approaches. The aim of this study, was to compare the outcomes of surgical bladder stone management in our single tertiary center.

Methods and materials: The 159 children younger than 18 years with vesical stones treated during January 2000 to January 2015 in Shohada e Tajrish hospital, Tehran, Iran that 146 subjects entered to the study. According to type of intervention, patients stratified to three groups. First group was included 80 patient’s that open cystolithotomy(OCL) was done for them, second group, 39 patients who underwent percutaneous cystolithotomy(PCCL)and third group,27 patients who treated by transurethral cystolithotripsy with holmium-YAG laser(TULL). Demographic data, operation time, hospital stay, and post operation complications were extracted and compared between groups.

Results: Mean age was 8.3±5.1 years (8.6±5.1, 6±4.2 years for boys and girls, respectively). Mean stone size was 2.76±1.07 cm that was not significant between three groups but it was larger in OCL group. Mean operative time was 29.15(±7.12) min that in separate, mean operative time in TULL was significantly higher than PCCL and OCL respectively (36.3±5.97, 30.54±5.27 and 26.06±6.32 min/P:0.000). Mean hospital stay in OCL group was 3.55±1 day that was higher than PCCL and TULL groups significantly (P=0.000).

Conclusion: based on our study, Ho:YAG lithotripsy is a safe with high success rate minimally invasive management method for children bladder calculi if proper equipment was available and done in expert hands.


Bladder stone; Children; Open cystolithotomy; Percutaneous cystolithotomy; Transurethral cystolithotripsy; Holmium-YAG laser.


Yoshida O. A chronological and geographical study on urolithiasis in Japan. Jpn J Endourol ESWL. 1990;3:5-10.

Schwartz BF, Stoller ML. The vesical calculus. Urol Clin North Am. 2000;27(2):333-346.

Trinchieri A. Epidemiology of urolithiasis: an update. Clin Cases Miner Bone Metab. 2008;5(2):101-106.

Abarchi H, Hachem A, Erraji M, Belkacem R, Outarahout N, Barahioui M. [Pediatric vesical lithiasis. 70 case reports]. Ann Urol (Paris). 2003;37(3):117-119.

Menon M. Urinary lithiasis: etiology, diagnosis, and medical management. In: Walsh PC, ed. Campbell’s Urology. Saunder; 2002: 3229-3305.

Torricelli FC, Mazzucchi E, Danilovic A, Coelho RF, Srougi M. Surgical management of bladder stones: literature review. Rev Col Bras Cir. 2013;40(3):227-233.

Ahmadnia H, Younesi Rostami M, Yarmohammadi AA, Parizadeh SM, Esmaeili M, Movarekh M. Percutaneous treatment of bladder calculi in children: 5 years experience. Urol J. 2006;3(1):20-22.

Razzaghi MR, Fallah Karkan M, Ghiasy S, Javanmard B. Laser Application in Iran Urology: A Narrative Review. J Lasers Med Sci. 2018;9(1):1-6. doi:10.15171/jlms.2018.01

Fallah Karkan M, Ghiasy S, Ranjbar A, Javanmard B. Evaluation of 200 Mm, 365 Mm and 500 Mm fibers of Ho:YAG laser in transurethral lithotripsy of ureteral: a randomize control trial. J Lasers Med Sci. 2018;9(1):69-72. doi:10.15171/jlms.2018.14

Papatsoris AG, Varkarakis I, Dellis A, Deliveliotis C. Bladder lithiasis: from open surgery to lithotripsy. Urol Res. 2006;34(3):163-167. doi:10.1007/s00240-006-0045-5

Aboulela W, ElSheemy MS, Shoukry AI, et al. Transurethral Holmium Laser Cystolithotripsy in Children: Single Center Experience. J Endourol. 2015;29(6):661-665. doi:10.1089/ end.2014.0636

Lal B, Paryani JP, Memon SU. Childhood bladder stones-an endemic disease of developing countries. J Ayub Med Coll Abbottabad. 2015;27(1):17-21.

Al-Marhoon MS, Sarhan OM, Awad BA, Helmy T, Ghali A, Dawaba MS. Comparison of endourological and open cystolithotomy in the management of bladder stones in children. J Urol. 2009;181(6):2684-2687; discussion 2687- 2688. doi:10.1016/j.juro.2009.02.040

Teichman JM, Rogenes VJ, McIver BJ, Harris JM. Holmium:yttrium-aluminum-garnet laser cystolithotripsy of large bladder calculi. Urology. 1997;50(1):44-48. doi:10.1016/s0090-4295(97)00201-x

Grasso M. Experience with the holmium laser as an endoscopic lithotrite. Urology. 1996;48(2):199-206. doi:10.1016/s0090-4295(96)00158-6

Ahmadnia H, Kamalati A, Younesi M, Imani MM, Moradi M, Esmaeili M. Percutaneous treatment of bladder stones in children: 10 years experience, is blind access safe? Pediatr Surg Int. 2013;29(7):725-728. doi:10.1007/s00383- 013-3320-x

Isen K, Em S, Kilic V, Utku V, Bogatekin S, Ergin H. Management of bladder stones with pneumatic lithotripsy using a ureteroscope in children. J Endourol. 2008;22(5):1037-1040. doi:10.1089/end.2007.0342

Wollin TA, Singal RK, Whelan T, Dicecco R, Razvi HA, Denstedt JD. Percutaneous suprapubic cystolithotripsy for treatment of large bladder calculi. J Endourol. 1999;13(10):739-744. doi:10.1089/end.1999.13.739

Ramakrishnan PA, Medhat M, Al-Bulushi YH, Gopakumar KP, Sampige VP, Al-Busaidy SS. Holmium laser cystolithotripsy in children: initial experience. Can J Urol. 2005;12(6):2880-2886.

Nameirakpam S, Naorem S, Faridi MS, Akoijam KS, Sinam RS. Transurethral Cystolithotripsy of Large Bladder Stones by Holmium Laser as a Day Care Procedure. J Clin Diagn Res. 2016;10(12):Pc01-pc02. doi:10.7860/ jcdr/2016/22493.8958

Salah MA, Holman E, Khan AM, Toth C. Percutaneous cystolithotomy for pediatric endemic bladder stone: experience with 155 cases from 2 developing countries. J Pediatr Surg. 2005;40(10):1628-1631. doi:10.1016/j. jpedsurg.2005.06.039

DOI: https://doi.org/10.22037/jlms.v9i3.20480