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Original Article a COMPARISON BETWEEN TRANSURETHRAL CYSTOLITHOCLASTY and VESICOLITHOTOMY in PEDIATRIC MALE PATIENTS

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Original Article a COMPARISON BETWEEN TRANSURETHRAL CYSTOLITHOCLASTY and VESICOLITHOTOMY in PEDIATRIC MALE PATIENTS Original Article A COMPARISON BETWEEN TRANSURETHRAL CYSTOLITHOCLASTY AND VESICOLITHOTOMY IN PEDIATRIC MALE PATIENTS Muhammad Khalid a, Muhammad Faizan b, Muhammad Asif Gurmani c , Amjad Ali Siddiquid , Qadeer Ahmed Choudhary e , Zulfiqar Anjumf aAssociate Professor, HOD Urology, D.G Khan Medical College, Dera Ghazi Khan. bMedical Officer, THQ Hospital Kot Chutta, Dera Ghazi Khan. cAssistant Professor, Department of Urology, D.G Khan Medical College, Dera Ghazi Khan. dDistrict Consultant, Department of Urology, D.G Khan Medical College, Dera Ghazi Khan. eAssociate Professor, Department of Urology Sahiwal Medical College, Sahiwal. fAssociate Professor, Department of Pediatric Surgery, D.G Khan Medical College, Dera Ghazi Khan. ABSTRACT: BACKGROUND & OBJECTIVE: To compare transurethral cystolithoclasty with ureteroscope over open vesicolithotomy in pediatric male patients. METHODOLOGY: Study comprises of hundred pediatric male patients, divided into two equal groups of 50 each, labeled as Group-A and Group-B. All the patients having stones less than 20mm size (average 14mm) were included. Group-A patients were treated with transurethral cystolithoclasty by using ureteroscope and pneumatic lithoclast assisted with the help of Dormia basket. Group-B patients were treated with open vesicolithotomy. RESULTS: All hundred male pediatric patients were between the ages of 1-15 years (mean age 8 years). Hospital stay was 2-3 days (average 2.5 days) in Group-A patients and 3-5 days (average 4 days) in Group-B patients. In Group-A3 (6%) patients had urinary tract infection, 1(2%) had urethral injury and 2(4%) had residual stone post-operatively. While Group-B4 (8%) suffered from urinary tract infection, 1(2%) had wound infection, 1(2%) had hematuria, and 2(4%) had fever. Retention of urine was 1(2%) in each Group. CONCLUSION: Transurethral cystolithoclasty is a much better way of treating vesical calculus in pediatric male patients because it is a procedure with short hospital stay, minimal invasion, no scar and less complication. KEYWORDS: Bladder Calculus, Comparison, Cystolithoclasty, Ureteroscope, Pneumatic Lithoclast, Dormia basket, Vesicolithotomy. doi: https://doi.org/10.37723/jumdc.v11i1.163 How to cite this: Khalid M, Faizan M, Gurmani MA, Siddiqui AA, Choudhary QA, Anjum Z. A COMPARISON BETWEEN TRANSURETHRAL CYSTOLITHOCLASTY AND VESICOLITHOTOMY IN PEDIATRIC MALE PATIENTS. jumdc. 2020;11(1):31-38. doi: https://doi.org/10.37723/jumdc.v11i1.163 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. JUMDC Vol. 11, Issue 1, January-March 2020 31 KHALID M., FAIZAN M., et al. A COMPARISON BETWEEN TRANSURETHRAL INTRODUCTION: Corresponding Author: Bladder calculus is a disease that has been Dr. Muhammad Khalid, vanished mysteriously, a least from affluent Associate Professor, HOD Urology, D.G Khan Medical College, Dera Ghazi Khan. industrialized countries but in past bladder Email: [email protected] calculi were more frequent in west and people tolerating this disease had risked their lives to get relief. Lithotomy or "Stone Cutting" via mostly used in managing large bladder calculi. perineal route was that last source of help Endoscopic procedures are being carried out in before 1800s- an extremely unpleasant all the teaching hospitals of Punjab including procedure with high mortality[1]. However Teaching hospital Dera Ghazi Khan and in urinary bladder is the most common site for certain District hospitals also. The aim of our stone formation among the children and work is to help the male children of bladder categorized as primary idiopathic / endemic calculus with the maximum benefits of secondary and migrant. cystoscopic procedure that is why we have History of bladder calculus goes parallel with compared new adapting procedure with most civilization and its roots go back to ancient common conventionally used procedure i.e. Egyptians. Oldest bladder calculus was c y s t o s c o p i c l i t h o c l a s t y v e r s u s o p e n discovered in an Egyptians Mummy, dated vesicolithotomy. about 4800 BC. Hippocrates (460-377 BC) defined the symptoms of bladder calculus, he METHODOLOGY: told in his famous Oath of Medical Ethics "I will not cut for the stone, but will leave this to be A comparative study was conducted with done by practitioners of this work" At that time prospective data collection in Department of lithotomy via perineal root was the last Urology, Teaching hospital Dera Ghazi Khan, treatment and wound of bladder was from October 2016 to October 2018 for a period considered lethal [2,3]. Suprapubic Lithotomy was of two years. The study has been approved by first performed by Pierre Franco in 1561. The the Ethical review committee of Teaching incidence of vesical calculi has declined Hospital Dera Ghazi Khan. Hundred pediatric significantly in developed nations due to male patients were included in this study. nutritional and socioeconomic advancements [4]. Patients having vesical calculus in The recurrence of stone in Pediatric patients is neurogenic bladder , bladder diverticulae, very high so every effort should be made to Calculus with post urethral valves, urethral completely clear the stone. This is a greater strictures, vesico-cutaneous fistula , age challenge despite minimal invasive surgery and below 1year and above 15 year in male ESWL restrictions. To avoid stone reformation patients and all the female patients were risk factors like anatomical and metabolic to be excluded from our study. assessed by evaluating the diet, urine and stone Male pediatric patients between the age 1 to15 analysis [5]. years having single calculus size less than Bladder calculus is a common problem in 20mm were included in this study. Pakistan. It is the most prevailing disorder in Patients were selected and randomly divided poor class people with high incidence in into two Groups of fifty each. In Group-A childhood and adolescence. Bladder calculi are patients, transurethral cystolithoclasty was managed by different modalities including open done with help of ureteroscope and pneumatic v e s i c o l i t h o t o m y, e x t r a c o r p o r e a l o r lithoclast, large few pieces were removed with endocorporeal lithotripsy and endoscopic help of dormia basket and rest of the sand cystolitholapaxy or cystolithoclasty via a particles were left for spontaneous passage. At retrograde or ante grade approach, depending the end of procedure Foley catheter 8-12Fr was upon the availability of skills and gadgets. placed for 1-3 days in Group-A patients. In ESWL is the first line of treatment in majority of Group-B patients, open vesicolithotomy was patients preferably in children [6,7] .In Pakistan done by giving Pfannenstiel's incision and Foley conventional open vesicolithotomy procedure is catheter of 8-12Fr was passed for 3-5 days 32 JUMDC Vol. 11, Issue 1, January-March 2020 KHALID M., FAIZAN M., et al. A COMPARISON BETWEEN TRANSURETHRAL post-operatively. All the male pediatric patients In Group-A 50 patients and in Group-B 50 were operated under General Anesthesia and a patients. Mean ± S.D of Group-A and Group-B is single dose of prophylactic antibiotic was given respectively 2.5 ± 0.5802, 4 ± 1.2616. Anova to all patients pre-operatively. All the patients results found to be Significant results between w e r e e va l u a t e d b y h i s t o r y, p h y s i c a l groups because p-value is <0.05 table-I. examination, complete blood count, renal In Group-A patients, hospital stay was from 2-3 function test, complete urine, ultrasound and x- days (average 2.5 days) and in Group-B from 3- ray KUB, clotting factors and virology of 5 days (average 4 days). Post-operatively hepatitis. Comparative data regarding age, urethral catheterization was done from 1-3 days hospital stay, expenses, catheter duration, (average 2 days) in Group-A, and from 3-5 days stone free rate and complications were collected (average 4 days) in Group-B patients. Average carefully. expenses of 2500 Rs in Group-A and 4000 Rs in In Group-A patients undergoing cystoscopic Group-B were noted. Expenses in Group-A were procedure hospital stay was 2-3 days (1 day less as compared to Group-B due to short pre-operatively and 1-2 days post-operatively) hospital stay. Stone free rate was 96% in and in Group-B patients treated by open Group-A and 100% in Group-B. All the results vesicolithotomy hospital stay was 3-5 days (2 are shown in Figure-I (A-D) and the statistical days pre-operatively and 2-3 days post- application like one-way Anova was applied. It operatively). Expenses of 1000 Rupees per day was observed a significant difference (P-value ≤ were noted in all pediatric male patients either 0.05) between both Groups-A and B on the undergoing cystoscopic procedure or basis of three parameters such as hospital stay, conventional open vesicolithotomy. In Group- Post-operatively urethral catheterization and A, complications of urethral injury, retention of hospital expanses while in the case of stone free urine due to residual stone, and urinary tract rate the difference was no significant or stone infection were carefully handled. Patients with free survival in the group was a little better. urethral injury and retention of urine were Patients undergoing cystoscopic procedure catheterized for five days. In patients having developed less complications (10%) post- residual stone cystoscopic procedure was operatively as compared to the patients treated repeated, and patients with urinary tract by open vesicolithotomy (18%).
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