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 and was almost going into urinary retention. Urine test showed 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

Xray showing stone in posterior urethra

Ultrasound showing stone in posterior urethra

PCCL surgery is progress

Small cut at end of PCCL

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. These surgeries are done by Pediatric urologists in India.
• 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 occurrence, 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.

Dr A.K.Singal is an expert & top pediatric urologist in Navi Mumbai India and he runs a special kidney stone clinic for children. Urinary stones are becoming more common in children and for their best treatment we need small equipment and trained surgeons who understand a child’s delicate body.

Pls fill up an enquiry form to contact his team Enquiry form