兒童膀胱結石的微創治療：個案報告與文獻回顧

王煥凱、蘇家震

奇美醫學中心外科部泌尿科

Minimally Invasive Management of Bladder Stones in pediatric patient: A case report and literature review

Huan-Kai Wang, Chia-Cheng Su

Divisions of Urology, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan

Purpose:

Bladder stones are rare in children. There are three basic types of bladder calculus: Primary idiopathic/endemic, secondary, and migrant. The standard treatment of bladder calculus is open cystolithotomy or transurethral cystolitholapaxy. Minimally invasive surgery seems to be nowadays the procedure of choice to treat pediatric patients with bladder stones. This study aimed to analyze retrospectively our experience with transurethral cystolitholapaxy with Holmium laser in children with bladder stones.

Case presentation:

A four-year-old boy presented with fever two months ago. The boy was brought to our hospital for help and the urinary tract infection was diagnosed. After antibiotic treatment and supportive care, his clinical conditions got better. Ultrasonography of the urinary tract found three bladder stones. CT revealed three large UB stones, up to 2.2 cm. The operation of  transurethral cystolitholapaxy with Holmium laser was done. We use the 10Fr cystoscope and Holmium laser to fragment the bladder stones. Due to small sheath size, the stones must be fragmented into dust and washed out with normal saline. After the surgery, the Foley catheter was removed on the next day and there was no fever or dysuria.

Clinical discussion:

Bladder stone is very rare in the pediatric population. The development of the laser power helps minimally invasive surgery. Compared to open cystolithotomy, transurethral cystolitholapaxy makes less damage in pediatric patients.

Conclusion:

Transurethral cystolitholapaxy of bladder stones in children was safe and effective. Under the development of laser power, endourological management was not only indicated in smaller stones with a diameter < 10 mm, but also feasible treatment for bladder stones larger than 20 mm.