Assessing the Efficacy and Safety of Minimally Invasive Versus Open Bladder Stone Removal in Pediatric Patients
DOI:
https://doi.org/10.52206/jsmc.2025.15.3.1203Abstract
Background: Pediatric bladder stones, although relatively uncommon, pose significant clinical challenges due to their potential to cause urinary obstruction, recurrent urinary tract infections (UTIs), and bladder dysfunction. Effective and minimally invasive treatment options are essential for improving patient outcomes in this population.
Objective: To compare percutaneous cystolithotripsy (PCCL) and open vesicolithotomy (OV) in pediatric patients aged 5–15 years, evaluating stone removal efficacy, operative duration, length of hospital stay, and postoperative complication rates.
Methodology: This retrospective comparative study was conducted at the Urology Department of Saidu Group of Teaching Hospitals, Swat. A total of 98 pediatric patients (aged 5–15 years) diagnosed with bladder stones were included, with 52 undergoing PCCL and 46 undergoing OV. Data were collected on demographic characteristics, stone size, presenting symptoms, operative time, stone clearance, hospital stay, and complications. Categorical variables were analyzed using the Chi-square test, while continuous variables were assessed with the Student’s t-test.
Results: Baseline characteristics, including age (p=0.28), gender (p=0.71), and stone size (p=0.42), were comparable between groups. The mean operative time was significantly lower in the PCCL group (45.6 ± 8.3 minutes) compared to the OV group (72.4 ± 12.7 minutes, p<0.001). Similarly, hospital stay was significantly shorter for PCCL patients (1.9 ± 0.6 days) versus OV patients (3.5 ± 1.2 days, p<0.001). Stone clearance rates were high and similar in both groups, with no statistically significant differences in complication rates such as UTIs, hematuria, or wound infections.
Conclusion: PCCL offers a safe and effective alternative to OV in pediatric patients with bladder stones, providing the advantages of shorter operative time and reduced hospital stay without increasing complication risks.
Keywords: Cystolithotomy, Minimally Invasive Surgical Procedures, Pediatrics, Treatment Outcome, Urinary Bladder Calculi.
References
Wiener JS, Huck N, Blais AS, Rickard M, Lorenzo A, Di Carlo HN, et al. Challenges in pediatric urologic practice: a lifelong view. World J Urology. 2021 Apr;39:981-91. https://doi.org/10.1007/s00345-020-03203-1
Mattoo TK, Shaikh N, Nelson CP. Contemporary management of urinary tract infection in children. Pediatr. 2021 Feb 1;147(2):34-9. https://doi.org/10.1542/peds.2020-012138
Olson P, Dudley AG, Rowe CK. Contemporary management of urinary tract infections in children. Curr Treat Option Pediatr. 2022 Sep;8(3):192-210. https://doi.org/10.1016/j.jpedsurg.2024.05.009
Kachewar SG, Kulkarni DS. An imaging review on urinary tract calcifications. IJARS. 2013;2(1):19-28.
Adhikari R, Baral HP, Bhattarai U, Gautam RK, Kunwar KJ, Shrestha D, et al. A rare case report of giant urinary bladder stone causing recurrent dysuria in a woman. Case Rep Urol. 2022;2022(1):4835945. https://doi.org/10.1155/2022/4835945
Sager C, Barroso Jr U, Netto MB, Retamal G, Ormaechea E. Management of neurogenic bladder dysfunction in children update and recommendations on medical treatment. Int Braz J Urol. 2022 Jan 12;48:31-51. https://doi.org/10.1590/S1677-5538.IBJU.2020.0989
Güzel R, Yildirim Ü, Sarica K. Contemporary minimal invasive surgical management of stones in children. Asian J Urol. 2023 Jul 1;10(3):239-45. https://doi.org/10.1016/j.ajur.2023.02.001
Kahraman O, Dogan HS, Asci A, Asi T, Haberal HB, Tekgul S. Factors associated with the stone?free status after retrograde intrarenal surgery in children. Int J Clin Pract. 2021 Oct;75(10):e14667. https://doi.org/10.1111/ijcp.14667
Davis NF, Donaldson JF, Shepherd R, Neisius A, Petrik A, Seitz C, et al. Treatment outcomes of bladder stones in children with intact bladders in developing countries: A systematic review of> 1000 cases on behalf of the European Association of Urology Bladder Stones Guideline panel. J Pediatr Urology. 2022 Apr 1;18(2):132-40. https://doi.org/10.1016/j.jpurol.2022.01.007
Khadgi S, Shrestha B, Ibrahim H, Shrestha S, ElSheemy MS, Al-Kandari AM. Mini-percutaneous nephrolithotomy for stones in anomalous-kidneys: a prospective study. Urolithiasis. 2017 Aug;45:407-14. https://doi.org/10.1007/s00240-016-0926-1
Donaldson JF, Ruhayel Y, Skolarikos A, MacLennan S, Yuan Y, Shepherd R, et al. Treatment of bladder stones in adults and children: a systematic review and meta-analysis on behalf of the European Association of Urology Urolithiasis Guideline Panel. Eur Urol. 2019 Sep 1;76(3):352-67. https://doi.org/10.1016/j.eururo.2019.06.018
Shalaby EA. Assess the safety and effectiveness of a novel approach during transurethral pneumatic cystolithotripsy in large urinary bladder stone: quasi-clinical trial. Urolithiasis. 2022 Apr;50(2):189-97. https://doi.org/10.1007/s00240-021-01294-y
Lentz RJ, Argento AC, Colby TV, Rickman OB, Maldonado F. Transbronchial cryobiopsy for diffuse parenchymal lung disease: a state-of-the-art review of procedural techniques, current evidence, and future challenges. J Thoracic Dis. 2017 Jul;9(7):2186. https://doi.org/10.21037/jtd.2017.06.96
Y?ld?z A, An?l H, Erol ?, Karam?k K, Erçil H. Comparison of three different modalities for the treatment of bladder calculi by size. Urologia J. 2022 Aug;89(3):413-7. https://doi.org/10.1177/03915603211020469
Hussain I, Qureshi MF, Kanjoo SR, Rashid A. Comparison of percutaneous cystolitholepexy with vesicolithotomy in peadiatric age group for safety and efficacy. Professional Med J. 2020; 27(8):1742-1746. https://doi.org/10.29309/TPMJ/2020.27.08.4130
Bhatti MS, Khuhro AQ, Brohi IB. Vesical stone management by percutaneous cystolitholapexy versus open vesicolithotomy among children. Professional Med J. 2021; 28(12):1742-1746. https://doi.org/10.29309/TPMJ/2021.28.12.6419
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 The authors retain the copyrights. Authors are permitted and encouraged to post their work online (e.g. in institutional repositories or on their website), as it can lead to productive exchanges, as well as greater citation of published work.

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.



