Vesical Calculus in a Patient with Cerebral Palsy—Challenges in Management

Cerebral palsy (CP) is a group of permanent clinical syndromes which are characterized by motor and postural dysfunction. Urolithiasis is a unique challenge in children with neurologic disorders and those with CP. It is very important to formulate a safe and effective anesthetic plan for CP patients. A teenage male of around 17 years, diagnosed with CP for ten years, presented with complaints of pain abdomen for four years. Investigations revealed a vesical calculus of 14 mm. The patient underwent transurethral cystolithotripsy under spinal anesthesia and sedation. During the procedure, there were many difficulties faced, such as inability to place patient in lithotomy position and also challenges in administering anesthesia. In this article, we will discuss how we overcame the difficulties and successfully performed the case. When encountering such a case, it is better to pre-plan the procedure with the anesthetist due to the challenges that might be faced in managing such a case. Also, if conventional cystolithotripsy cannot be performed for any reason, and then percutaneous cystolithotripsy can also be performed.