A boy with impacted urethral stone managed by PCCL

S.N., 4 years old boy came with difficulty in passing urine and blood in urine. The boy used to really struggle and strain while passing urine. Urine test some red blood cells and mild infection. We suspected some form of obstruction in urine flow such as a stone (calculus) in the bladder or urethra. A plain x-ray showed a small (9mm) stone stuck in posterior urethra and this was confirmed on Ultrasound also (pics 1&2).

The child was taken up for PCCL (Percutaneous Cystolithotripsy). Initially a cystoscopy was done and the stone was pushed into bladder, then a small channel was made into the bladder through which a telescope and some instruments to crush the stone were passed. The stone was broken into 3-4 small pieces which were then removed. End result (pic4) a 5mm cut and a very rapid recovery. The child went home the same day.

PCCL is a very advanced Endourological Surgery for removing bladder stones. The main advantage is in fast recovery
 
DTPA scan showing Left PUJO, there is significant retention of tracer
even at 2 hours. Curve is non-draining type
DTPA scan 6 months after surgery showing good drainage and normal drainage curve.
   
Direct access into bladder PCCL Small 5 mm cut at the end
Facts about Endourology and urinary stones in children
  • Endourology involves surgeries within the urinary system through the natural channels or small holes using miniaturised telescopes.

  • Pediatric endourology had its advent 3 decades back with availability of Pediatric cystoscopes which can be used in small infants safely.

  • Most common type of endourological surgeries in children are Posterior urethral valves ablation (case4), DJ stenting or for urinary stones.

  • Urinary stones in children are relatively uncommon and thus require thorough investigation as to find the underlying factors leading to their occurence, especially if they occur in kidney or ureter.

  • If the underlying cause can be identified, then medical therapy may be advisable to prevent reformation of stones. This is vital in kids as they have further 70-80 years of life ahead of them.

  • Small kidney and ureteral stones (<6mm) are generally passed spontaneously without any surgery, rarely if the stone gets stuck in ureter it may require a Endourological Surgery in form of Uretrorenoscopy (URS).

  • Bladder stones can sometimes form without any underlying metabolic disorder and they are treated separately by PCCL or Cystolithotripsy.

  • PCCL is a very advanced Endourological Surgery for removing bladder stones. The main advantage is in fast recovery.

 
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