The size of the stone is the most important factor in determining the type of approach.
Transurethral cystolithotripsy (TUSL): It is the first option in children with small stones (<15 mm) and normal urethra anatomy. It is easy and practical, especially for girls. However, the risk of urethra injury increases if entry and exit are performed for a long time and repeatedly with large calibrated instruments.
Percutaneous suprapubic cystolithotripsy (PSL): It is a safe and successful method when performed appropriately and carefully. There is no risk of injury to the urethra. It has low morbidity and short hospital stay. It is frequently applied for medium-sized (15-30 mm) stones and stones in the enlarged bladder. The risk of complications may be increased in patients who have had previous lower abdominal or pelvic area surgery. The most important complication is bladder perforation, leakage of perivesical fluid and stone fragments.
Open cystolithotripsy: In very large (>30 mm) stones and in children with bladder augmentation, the stone can be removed in one piece in a short time. Suprapubic incision scar is the most important complication.
Urethra stones
Stones in the urethra are generally pushed into the bladder with a urethral catheter and broken and removed with TUSL. Stones that cannot be pushed into the bladder are broken down and removed by lasertripsy.
Urethra wall damage may occur in the early period and urethral stricture may develop in the late period.
Differences between children and adults in terms of minimally invasive approach in urinary stones:
Children are not miniatures of adults. Children continue to develop and grow and have unique characteristics that are completely different from adults due to their anatomy, physiology and more sensitive and exaggerated body reactions to external influences.
The main differences that distinguish children and their urinary systems from adults:
Since metabolic and anatomical disorders are more common in children, the risk of stone recurrence is high.
Complete stone-free status is more difficult in children due to their small and narrow urinary system.
Intraoperative cold irrigation fluid poses a risk of hypothermia and hyponatremia in children. .
Renal physiology is different in children. It is more sensitive to the serious pressure increase that occurs in the kidney and pelvicalyceal system during microPNL and RIRC.
Organ perforation, sepsis and bleeding in children during minimally invasive procedures. Major complications are more common in children.
In SWL, as the number of shock waves and power increases, the size of the lesion increases as the kidney size decreases. Additionally, SWL in children requires multiple treatment sessions with general anesthesia. This increases the risk of complications.
Adult-type large (>24 Fr) instruments used during PNL in the small and fragile kidneys of children increase the risk of complications.
Excessive dilatation of the small-caliber pediatric ureter during URS; It may cause ureteral perforation, ureteric stenosis and VUR.
Children's developing bodies are more affected by radiation. The risk of tumors is higher in the long term
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