Percutaneous cystolithotomy in the pediatric augmented bladder

Purpose: Bladder stones are a common problem following augmentation cystoplasty. With the addition of Mitrofanoff channels for intermittent catheterization and more aggressive bladder neck tightening procedures, the incidence of stones has increased and endoscopic access to the bladder has become more complicated. We present our results of percutaneous endoscopic cystolithotomy in children with bladder augmentation. Materials and Methods: We performed percutaneous extraction of bladder calculi in 13 children with bladder augmentation. All patients performed catheterization either via a Mitrofanoff channel, artificial urinary sphincter or plicated ileal limb of an ileocecal reservoir. The prior suprapubic tube site was dilated with an Amplatz set for access, and stones were removed intact or fragmented by laser or electrohydraulic lithotripsy. Results: Percutaneous extraction was successful in 12 of the 13 patients (92%). The remaining patient had a small posterior bladder perforation and open cystolithotomy was performed. All patients were discharged home in 24 to 36 hours, and there have been no stone recurrences with a mean followup of 24 months. Conclusions: Percutaneous stone removal using the previous suprapubic tract is a simple, effective and minimally invasive option for removing stones in an augmented bladder. This technique avoids potential injury to the continence mechanism of the reconstructed bladder neck or Mitrofanoff channel. Percutaneous stone removal has become our procedure of choice for managing calculi in the augmented bladder.