PERCUTANEOUS VACUUM VESICOLITHOTOMY UNDER DIRECT VISION - A NEW TECHNIQUE

Purpose: The number of vesical calculi is increasing as the number of patients with intestino-cystoplasty increases, We describe our techniq ue for easily removing vesical calculi in children via an atraumatic p ercutaneous endoscopic approach. Materials and Methods: The procedure involves percutaneous suprapubic puncture and direct visualization of the calculi via cystoscopy through the urethra or via a second suprapu bic puncture when the bladder neck is closed, The stones are vacuumed up I at a time with suction tubing through the suprapubic working shea th in a controlled manner with no urethral trauma. Ten patients 3 to 1 6 years old (mean age 8) with vesicolithiasis underwent percutaneous v acuum vesicolithotomy under direct vision in 1993 to 1995. Results: Tw o to 12 bladder calculi were extracted (mean 7), All calculi less than 1 cm. were removed by this procedure. All bladder calculi between 1 a nd 1.5 cm. were also removed but they required simultaneous electrohyd raulic lithotripsy, There were no complications at a mean 1-year follo wup. Mean hospitalization was less than 24 hours (range 0 to 3 days). Conclusions: Percutaneous vacuum vesicolithotomy is highly successful, easy to perform and safe for extracting vesical calculi, Since the pr ocedure is done through a percutaneous sheath, it is particularly suit ed to the individual with an absent, small caliber, sensitive or surgi cally reconstructed urethra.