Treatment of Bladder Stone in a Child
Clinical scenario
This protocol covers the management of a bladder stone (vesical calculus) in a paediatric patient. The child's age, urethral anatomy, stone size, and history of prior urinary tract surgery or dysfunction each influence the treatment pathway.
Treatment approach
For most children, an endoscopic approach is the preferred first-line intervention. Where this is not feasible — due to patient age, urethral anatomy, or other clinical factors — alternative surgical strategies are considered. The complete protocol specifies the decision pathway, the conditions under which each approach is selected, and what to do when standard options are not advisable.
Treatment goal
Stone-free status
References
- Offer children with bladder stones transurethral cystolithotripsy where possible.
- Offer children percutaneous cystolithotripsy where transurethral cystolithotripsy is not possible or is associated with a high risk of urethral stricture (e.g., young children, previous urethral reconstruction, and spinal cord injury).
- Suggest open cystolithotomy as an option for very large bladder stones in adults and children.
- Prefer "tubeless" procedure (without placing a catheter or drain) for children with primary bladder stones and no prior infection, surgery, or bladder dysfunction where open cystolithotomy is indicated.
- Open, laparoscopic, and extracorporeal shock wave lithotripsy are alternative treatments where endoscopic treatment is not advisable in adults and children.
- In both adults and children, transurethral cystolithotripsy provides high SFRs and appears to be safe, with a very low-risk of unplanned procedures and major post-operative and late complications.