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Aydamirov M, Karkin K. Comparison of two methods for treatment of 1-2 cm kidney stones in pediatric patients: mini PCNL and RIRS. Langenbecks Arch Surg 2024; 409:207. [PMID: 38976070 DOI: 10.1007/s00423-024-03402-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 07/02/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE This study aimed to compare the results of retrograde intrarenal surgery (RIRS) and mini-percutaneous nephrolithotomy (mini-PCNL) for the treatment of 1-2 cm kidney stones in pediatric patients. METHODS The records of patients under the age of 18 years who were diagnosed with unilateral 1-2 cm kidney stones for the first time and underwent endoscopic surgery between February 2008 and April 2022 were retrospectively examined. The patients were divided into two groups: mini-PCNL and RIRS surgery. Parameters such as age, gender, number of stones, side, size and localization were examined. The main endpoint of the study was to compare stone-free rates (SFR) one month after both surgeries. Surgery and fluoroscopy times, postoperative hospital stay, hemoglobin decrease and complication rates were compared between the groups. SFR was evaluated one month after surgery by direct urinary system radiography and USG or CT. RESULTS A total of 58 patients were included in the study. There were 35 patients in the mini-PCNL group and 23 patients in the RIRS group. Table 1 shows the demographic and clinical characteristics of both groups. There was no significant difference between the groups in terms of age, gender, stone size, location, side and density. Calcium oxalate stones were observed at a higher rate in both groups. Mean fluoroscopy time was higher in the mini-PCNL group (p = 0.001). The mean surgery time was lower in the mini-PCNL group (p = 0.024). The mean hemoglobin decrease was greater in the percutaneous group (p = 0.039). There were no differences between the groups in terms of postoperative hospital stay, complication rates, and SFR one month after surgery. CONCLUSION Although mini-PCNL seems to be more advantageous in terms of operation time compared to RIRS, it is disadvantageous in terms of average fluoroscopy time, radiation received and average hemoglobin decrease.
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Affiliation(s)
- Mubariz Aydamirov
- Department of Urology, Baskent University, Alanya A&R Center, Antalya, Türkiye
| | - Kadir Karkin
- Department of Urology, Adana City Training and Research Hospital, Health Sciences University, Adana, Türkiye.
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Shen R, Ming S, Qian W, Zhang S, Peng Y, Gao X. A novel post-percutaneous nephrolithotomy sepsis prediction model using machine learning. BMC Urol 2024; 24:27. [PMID: 38308308 PMCID: PMC10837989 DOI: 10.1186/s12894-024-01414-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/22/2024] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES To establish a predictive model for sepsis after percutaneous nephrolithotomy (PCNL) using machine learning to identify high-risk patients and enable early diagnosis and intervention by urologists. METHODS A retrospective study including 694 patients who underwent PCNL was performed. A predictive model for sepsis using machine learning was constructed based on 22 preoperative and intraoperative parameters. RESULTS Sepsis occurred in 45 of 694 patients, including 16 males (35.6%) and 29 females (64.4%). Data were randomly segregated into an 80% training set and a 20% validation set via 100-fold Monte Carlo cross-validation. The variables included in this study were highly independent. The model achieved good predictive power for postoperative sepsis (AUC = 0.89, 87.8% sensitivity, 86.9% specificity, and 87.4% accuracy). The top 10 variables that contributed to the model prediction were preoperative midstream urine bacterial culture, sex, days of preoperative antibiotic use, urinary nitrite, preoperative blood white blood cell (WBC), renal pyogenesis, staghorn stones, history of ipsilateral urologic surgery, cumulative stone diameters, and renal anatomic malformation. CONCLUSION Our predictive model is suitable for sepsis estimation after PCNL and could effectively reduce the incidence of sepsis through early intervention.
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Affiliation(s)
- Rong Shen
- Department of Urology, Shanghai Changhai Hospital, No.168 Changhai Rd, Shanghai, 200433, China
| | - Shaoxiong Ming
- Department of Urology, Shanghai Changhai Hospital, No.168 Changhai Rd, Shanghai, 200433, China
| | - Wei Qian
- Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, China
| | - Shuwei Zhang
- Department of Urology, Shanghai Changhai Hospital, No.168 Changhai Rd, Shanghai, 200433, China
| | - Yonghan Peng
- Department of Urology, Shanghai Changhai Hospital, No.168 Changhai Rd, Shanghai, 200433, China.
| | - Xiaofeng Gao
- Department of Urology, Shanghai Changhai Hospital, No.168 Changhai Rd, Shanghai, 200433, China.
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Juliebø-Jones P, Ulvik Ø, Beisland C, Somani BK. Paediatric percutaneous nephrolithotomy (P-PCNL) reporting checklist. Scand J Urol 2023; 58:115-119. [PMID: 37987596 DOI: 10.2340/sju.v58.13392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/06/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To develop a reporting checklist that serves to improve and standardise reporting in studies pertaining to paediatric percutaneous nephrolithotomy (PCNL). METHODS Based on findings from systematic review of literature, a draft list of items was formulated. By process of review and revisions, a finalised version was established and consensus achieved. RESULTS The finalised version of the checklist covers four main sections, which include the following areas: study details, pre-operative, operative and post-operative information. There are 18 further sub-items. Recommendations deemed to be of high importance to include are highlighted in bold. CONCLUSION This practical tool can aid clinicians and researchers when undertaking and reviewing studies on paediatric PCNL. This is highly relevant given the current heterogeneity that exists as well as debate in best practice patterns.
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway; EAU YAU Urolithiasis Group, Arnhem, The Netherlands.
| | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Zhan R, Ge Y, Liu Y, Zhao Z, Li J, Wang W. Microureteroscopy in the treatment of upper urinary tract stones in pediatric patients younger than 3 years of age. Urolithiasis 2023; 51:64. [PMID: 37014440 DOI: 10.1007/s00240-023-01435-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/25/2023] [Indexed: 04/05/2023]
Abstract
The aim of this study is to evaluate the usefulness of microureteroscopy (m-URS) in the treatment of renal and ureteral stones in children younger than 3 years of age. A retrospective analysis of pediatric patients aged < 3 years with upper urinary tract calculi who underwent lithotripsy was performed. The children were divided into the m-URS group (4.85 F, n = 41) and the ureteroscopy (URS) group (4.5/6.5 F, n = 42) according to the type of ureteroscope used. The mean age of the patients was 23.5 ± 10.7 months in the m-URS group and 20.6 ± 7.1 months in the URS group (P = 0.212). The success rate of one-stage surgery was 80.5% (33/41) for m-URS and 38.1% (16/42) for URS (P < 0.001). The success rates of m-URS were 60.0%, 69.2%, and 91.3% for stones located in the renal pelvis/calix, upper ureter, and mid-lower ureter, respectively. Eight children in the m-URS group and 26 children in the URS group underwent the second-stage ureteroscopic surgery. The mean operation time was 50 (30-60) min in the m-URS group and 40 (34-60) min in the URS group (P = 0.287). The complication rates were 4.9% and 7.1% in the m-URS and URS groups, respectively (P = 1.000). The stone-free rate at 1 month after lithotripsy was 87.8% in the m-URS group and 83.3% in the URS group (P = 0.563). The mean anesthesia session was 2.1 in the m-URS group and 2.5 in the URS group (P = 0.002). M-URS can effectively reduce the number of anesthesia sessions and is considered an alternative treatment for upper urinary tract calculi in selected pediatric patients younger than 3 years of age.
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Affiliation(s)
- Ruichao Zhan
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, 95 YongAn Road, Xicheng District, Beijing, 100050, China
| | - Yucheng Ge
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, 95 YongAn Road, Xicheng District, Beijing, 100050, China
| | - Yukun Liu
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, 95 YongAn Road, Xicheng District, Beijing, 100050, China
| | - Zhenqiang Zhao
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, 95 YongAn Road, Xicheng District, Beijing, 100050, China
| | - Jun Li
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, 95 YongAn Road, Xicheng District, Beijing, 100050, China
| | - Wenying Wang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, 95 YongAn Road, Xicheng District, Beijing, 100050, China.
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Yuan Y, Liang YN, Li KF, Ho YR, Wu QL, Zhao Z. A meta-analysis: retrograde intrarenal surgery vs. percutaneous nephrolithotomy in children. Front Pediatr 2023; 11:1086345. [PMID: 37205217 PMCID: PMC10185757 DOI: 10.3389/fped.2023.1086345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Backgrounds The increasing prevalence of pediatric kidney stones worldwide makes minimally invasive lithotripsy like retrograde intrarenal surgery (RIRS) and percutaneous Nephrolithotomy (PCNL) more prevalent. However, their safety and efficacy are controversial. Consequently, a meta-analysis of the comparison between RIRS and PCNL is conducted. Methods Clinical trials were selected from PubMed, EMBASE, Scopus, and Cochrane Library databases. The data extraction and study quality assessment were performed by two individuals independently. The data relating to therapeutic effects were extracted and analyzed by Review manager 5.4. Results Thirteen studies involving 1,019 patients were included. The micro-PCNL excelled in stone-free rate (P = 0.003), postoperative fever rate (P = 0.02), and Clavien-Dindo II complications (P = 0.05). Notably, the mean age of the micro-PCNL group was younger than other groups (P = 0.0005). The operation time in mini-PCNL was longer than RIRS (P < 0.00001) but with high heterogeneity (I2 = 99%). There was no difference in Clavien-Dindo I, II, and III complications between the PCNL and the RIRS, but mini-PCNL showed a higher probability than RIRS in Clavien-Dindo I (P = 0.0008) and II complications (P = 0.007). Conclusions Compared with RIRS, micro-PCNL could be a better therapeutic option for kidney stones in children. Of note, more parameters should be analyzed to illustrate the efficacy of different minimally invasive surgeries for pediatric kidney stones due to poor cases in our study. Systematic Review Registration https://www.crd.york.ac.uk/prospero/#recordDetails, PROSPERO CRD42022323611.
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Affiliation(s)
- Yi Yuan
- Department of Pediatric Urology Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Yan-nei Liang
- Department of Pediatric Urology Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Kai-feng Li
- Department of Pediatric Urology Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Yi-ru Ho
- Department of Pediatric Urology Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Qian-long Wu
- Department of Pediatric Urology Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Zhang Zhao
- Department of Urology Surgery, Guangzhou Women and Children’s Medical Center of Guangzhou Medical University, Guangzhou, China
- Correspondence: Zhang Zhao
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Simayi A, Tayier T, Aimaier A, Lei P, Zhang X, Alimu Y. Ultrasound-guided mini-percutaneous nephrolithotomy in the treatment of upper urinary tract stones in children: A single-center evaluation. Asian J Surg 2023; 46:1-5. [PMID: 35216876 DOI: 10.1016/j.asjsur.2022.01.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 01/06/2023] Open
Abstract
To evaluate the safety and efficacy of ultrasound-guided mini-percutaneous nephrolithotomy (mini-perc) for the treatment of upper urinary tract stones in children. We reviewed the records of 70 children with upper urinary tract stones who were treated with a mini-perc technique between July 2015 and April 2020. All puncture site selections and tract dilations were determined by Doppler ultrasonography. Patient age, height, weight, stone size, operation time, stone-free rate (SFR), postoperative complications, tubeless rate, and length of hospital stay (LOS) were recorded. Stone components were analysed using infrared spectroscopy. A total of 47 boys and 23 girls were included. Median weight and height of the patients were 18.5 kg and 110 cm, respectively. Median stone diameter was 2.0 cm. Median time to establish access was 4.0 min and median operation time was 25 min. Patients had median preoperative and postoperative haemoglobin levels of 121 and 113.5 g/L, median haemoglobin levels dropped to 8.0 g/L the day after surgery. No patient needed a blood transfusion. Eight children (11.4%) developed significant complications, including four cases with Clavien Grade I, one with Clavien Grade II, and three with Clavien Grade Ⅲ complications. One-day and 1-month follow-ups revealed a complete SFR of 95.7% (67/70) and 97.1% (68/70), respectively. Fifty-six patients (80.0%) did not require catheters of any type (total tubeless). Median LOS was 2.0 days. Ultrasound-guided mini-perc is safe and effective. The mini-perc technique is a feasible alternative for paediatric stone disease that does not result in major complications.
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Affiliation(s)
- Abulizi Simayi
- Department of Urology, People's Hospital of Xinjiang Uyghur Autonomous Region, Tianchi Road, Tianshan District, Urumqi, 830001, China
| | - Talaiti Tayier
- Department of Urology, People's Hospital of Xinjiang Uyghur Autonomous Region, Tianchi Road, Tianshan District, Urumqi, 830001, China.
| | - Aihemaiti Aimaier
- Department of Urology, People's Hospital of Xinjiang Uyghur Autonomous Region, Tianchi Road, Tianshan District, Urumqi, 830001, China
| | - Peng Lei
- Department of Urology, People's Hospital of Xinjiang Uyghur Autonomous Region, Tianchi Road, Tianshan District, Urumqi, 830001, China
| | - Xiaoan Zhang
- Department of Urology, People's Hospital of Xinjiang Uyghur Autonomous Region, Tianchi Road, Tianshan District, Urumqi, 830001, China
| | - Yalikun Alimu
- Department of Urology, People's Hospital of Xinjiang Uyghur Autonomous Region, Tianchi Road, Tianshan District, Urumqi, 830001, China
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7
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Quiroz Y, Somani BK, Tanidir Y, Tekgul S, Silay S, Castellani D, Lim EJ, Fong KY, Garcia Rojo E, Corrales M, Hameed BMZ, Llorens E, Teoh JYC, Dogan HS, Traxer O, Bujons Tur A, Gauhar V. Retrograde Intrarenal Surgery in Children: Evolution, Current Status, and Future Trends. J Endourol 2022; 36:1511-1521. [PMID: 35972727 DOI: 10.1089/end.2022.0160] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Introduction: Incidence of urolithiasis in children has increased in recent years and with technological advancements and miniaturization of surgical instruments, pediatric urologists have acquired an impressive arsenal for their treatment. Retrograde intrarenal surgery (RIRS) has gained widespread popularity as it is a natural extension of semirigid ureteroscopy and can be done through natural orifice minimizing the morbidity of percutaneous access. The aim of this narrative review is to describe how RIRS has evolved over the decades in children and if the age-related anatomical difference impacts reported outcomes especially stone-free rate (SFR) and complications. Materials and Methods: An electronic literature search from inception to October 15, 2021 was performed using Medical Subject Heading terms in several combinations on PubMed, EMBASE, and Web of Science without language restrictions. A total of 2022 articles were founded and 165 articles were full-text screening. Finally, 2 pediatric urologists included 51 articles that summarize the available literature regarding the development and use of RIRS in children. Results: RIRS as of today is well established as a superior modality for all stones in all locations compared with extracorporeal shockwave lithotripsy both in children and adults. The passive dilation has decreased the need of active ureteral dilation, but the need to perform prestenting is not defined yet. Regarding the use of the ureteral access sheath, the literature tends to lean toward its placement in most cases, but we do not know its long-term effects over the growth of children. Finally, the SFR has increased as the experience of pediatric urologists increases, as well as the number of complications has decreased. Conclusion: RIRS in pediatrics has crossed many milestones, yet many areas need further research and larger data are required to make RIRS the procedure of choice for renal stone management in children across all age groups.
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Affiliation(s)
- Yesica Quiroz
- Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Medical School, Hacettepe University, Ankara, Turkey
| | - Selcuk Silay
- Department of Urology, Istanbul Biruni University, Istanbul Medeniyet University, Istanbul Memorial Hospital, Istanbul, Turkey
| | - Daniele Castellani
- Department of Urology, Division of Urology, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Khi Yung Fong
- Department of Urology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Esther Garcia Rojo
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Mariela Corrales
- Department of Urology, Hôpital Tenon, Sorbonne University, Paris, France
| | - B M Zeeshan Hameed
- Department of Urology, Father Muller Medical College Mangalore, Karnataka, India
| | - Erika Llorens
- Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Hasan Serkan Dogan
- Division of Pediatric Urology, Department of Urology, Medical School, Hacettepe University, Ankara, Turkey
| | - Olivier Traxer
- Department of Urology, Hôpital Tenon, Sorbonne University, Paris, France
| | - Anna Bujons Tur
- Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, NUHS, Singapore, Singapore
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MAZZON G, ZHU W, ZENG G. Comment on: "Mini percutaneous nephrolithotomy versus standard percutaneous nephrolithotomy for the management of renal stones over 2 cm: a systematic review and meta-analysis of randomized controlled trials". Minerva Urol Nephrol 2022; 74:479-481. [DOI: 10.23736/s2724-6051.22.04963-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Thangavelu M, Sawant A, Sayed AA, Pawar P, Hamid M, Patil S, Bhise V, Mathews J, Shewale R, Gadodia M. Retrograde Intrarenal Surgery (RIRS) for upper urinary tract stones in children below 12 years of age: A single centre experience. Arch Ital Urol Androl 2022; 94:190-194. [PMID: 35775346 DOI: 10.4081/aiua.2022.2.190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Retrograde Intra Renal Surgery (RIRS) is a minimally invasive surgical modality for the treatment of renal stones. We evaluated the efficacy of RIRS in children below aged 12 years of age in the form of stone-free rate (SFR), complications and the feasibility of the procedure. MATERIALS AND METHODS This retrospective study included all children ≤ 12 years of age, with upper urinary tract stones single or multiple ≤ 15 mm in size who underwent RIRS between February 2019 to November 2021. RIRS was performed with 7.5 Fr flexible ureterorenoscope over the guidewire, the stones were dusted with Laser and the ureteral stent was left after RIRS. All patients had the post-procedure stent removed within 3 weeks after checking for residual stones with X-ray and ultrasonography of Kidney-Ureter-Bladder (USG-KUB). Follow-up USG KUB was done at 4 months. RESULTS 15 patients included in our study met the inclusion criteria. The mean age was 8.7 ± 2.8 years, the mean stone size was 11.26 ± 2.14 mm and 26.6 % had multiple stones. Retrograde access failure was noted in 36.3 % in non stented patients. The mean operative time was 72.6 ± 20 minutes, fluoroscopy time was 4.4 ± 0.9 minutes and the mean LASER time was 26 ± 3.9 minutes. The mean hospital stay was 2.8 ± 0.9 days. Ureteral access sheath (UAS) was used in one patient. Conversion to mini PCNL was done in one pre stented patient due to access failure and one patient had a second look RIRS for residual stone. No major complications were noted except onr patient who had sepsis. The stone-free rates were 93.3% after primary RIRS and 100% after second look RIRS. CONCLUSIONS RIRS is a feasible, safe procedure for pediatric upper urinary stones with excellent stone-free rates and a low rate of complications.
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Affiliation(s)
| | - Ajit Sawant
- Department of Urology, LTMC and General Hospital, Sion, Mumbai.
| | - Ali Abbas Sayed
- Department of Urology, LTMC and General Hospital, Sion, Mumbai.
| | - Prakash Pawar
- Department of Urology, LTMC and General Hospital, Sion, Mumbai.
| | - Mohamed Hamid
- Department of Urology, LTMC and General Hospital, Sion, Mumbai.
| | - Sunil Patil
- Department of Urology, LTMC and General Hospital, Sion, Mumbai.
| | - Vikas Bhise
- Department of Urology, LTMC and General Hospital, Sion, Mumbai.
| | - Jeni Mathews
- Department of Urology, LTMC and General Hospital, Sion, Mumbai.
| | - Raunak Shewale
- Department of Urology, LTMC and General Hospital, Sion, Mumbai.
| | - Mohan Gadodia
- Department of Urology, LTMC and General Hospital, Sion, Mumbai.
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10
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Quiroz Madarriaga Y, Badenes Gallardo A, Llorens de Knecht E, Motta Lang G, Palou Redorta J, Bujons Tur A. Can cystinuria decrease the effectiveness of RIRS with high-power ho:yag laser in children? Outcomes from a tertiary endourology referral center. Urolithiasis 2022; 50:229-234. [PMID: 35084538 DOI: 10.1007/s00240-022-01301-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 01/08/2022] [Indexed: 11/26/2022]
Abstract
Cystinuria, which is the cause of cystine urolithiasis, accounts for 2-6% of all urinary stones in children, has a low prevalence with a high recurrence rate, making this metabolic disorder a therapeutic challenge in pediatric population. The aim of this work is evaluate the efficacy and safety of retrograde intra-renal surgery (RIRS) in pediatric patients with cystinuria and kidney stones smaller than 2 cm. Prospective study of 64 stones treated in 22 retrograde intra-renal surgeries (RIRS) in cystinuric pediatric patients with renal or proximal ureteral stones less than 2 cm. Average age of 9.5 years. The following data were analyzed: demographics, stone characteristics and surgical data with intra- and postoperative complications. Location of the stones was 68.7% in the calyces, 20.3% in the renal pelvis, and 9.3% in the ureteropelvic junction; 41% of cases had multiple locations. The average cystinuria level before the procedure was 825 mg/dL. The anatomy of 73% of the interventions increased the difficulty of flexible ureteroscopy and decreased stone free rates, because distorted renal anatomy was present: sclerosis of the pelvis or infundibulum, abnormal calyceal dilations, or excluded calyces. Intraoperative complications occurred in 18.2% of the procedures. Reno-vesical ultrasound was performed in all patients in the first postoperative month, with an SFR of 59%. Cystinuric patients are a challenge for pediatric urologists, decreasing the effectiveness of RIRS. However, it could be better treatment than SWL and with fewer complications than PCNL in the pediatric population with this disease.
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Affiliation(s)
| | | | - Erika Llorens de Knecht
- Urology Department, Fundació Puigvert, Carrer de Cartagena, 340-350, 08025, Barcelona, Spain
| | - Guilherme Motta Lang
- Urology Department, Fundació Puigvert, Carrer de Cartagena, 340-350, 08025, Barcelona, Spain
| | - Joan Palou Redorta
- Urology Department, Fundació Puigvert, Carrer de Cartagena, 340-350, 08025, Barcelona, Spain
| | - Anna Bujons Tur
- Urology Department, Fundació Puigvert, Carrer de Cartagena, 340-350, 08025, Barcelona, Spain
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11
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Ultra-mini-PCNL using the urological Dyna-CT in small infants: a single-center experience. Int Urol Nephrol 2022; 54:979-984. [DOI: 10.1007/s11255-022-03150-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/06/2022] [Indexed: 11/29/2022]
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12
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Kahraman O, Dogan HS, Asci A, Asi T, Haberal HB, Tekgul S. Factors associated with the stone-free status after retrograde intrarenal surgery in children. Int J Clin Pract 2021; 75:e14667. [PMID: 34320260 DOI: 10.1111/ijcp.14667] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Paediatric urolithiasis has a recurrent nature because it is frequently associated with metabolic or anatomical disorders or infectious conditions. The rising incidence of the disease with its recurrent nature emphasises the need for minimally invasive therapeutic options. In this study, we aimed to evaluate efficacy and factors affecting the success of retrograde intrarenal surgery (RIRS) in children. MATERIALS AND METHODS Patients who underwent RIRS were evaluated retrospectively. Two different flexible ureteroscopes (F-URS) were used (7.5F F-URS and 7.95F with a 4.9F bullet-shaped tip). Irrespective of size, all residual fragments were considered as failure. Age, stone size, stone localisation, Hounsfield Unit (HU), stone-free rate (SFR) and complications were evaluated. RESULTS Forty-six patients (29 boys and 17 girls) with a median age of 70.5 months (6-214 months) were treated with RIRS between August 2014 and November 2019. The median operative time was 60 minutes (45-120 minutes). The median follow-up was 26 months (3-65 months). Fourteen patients had lower pole and 10 patients had multiple stones. Ureteral access sheath (UAS) was used in 16 (35%) patients. SFR was 61%. The median number of general anaesthesia was 2 (min 1, max 5). Auxiliary semirigid URS, PCNL and repeat RIRS were required in 4, 6 and 5 patients, respectively. Two patients had postoperative febrile urinary tract infection (UTI) as a complication. Age was associated with post-operative febrile UTI. Presence of stones with HU lower than 700, being operated 4.9F F-URS and without UAS were associated with better SFR. CONCLUSIONS RIRS is a minimally invasive method with low complication rates in the treatment of childhood stone disease. Higher stone-free rates are obtained in low HU stones and cases in which we used 4.9 F tip F-URS.
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Affiliation(s)
- Oguzhan Kahraman
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hasan Serkan Dogan
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ahmet Asci
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tariq Asi
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Serdar Tekgul
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Ozkent MS, Piskin MM, Balasar M, Goger YE, Sonmez MG. Is Retrograde Intrarenal Surgery as Safe for Children as It Is for Adults? Urol Int 2021; 105:1039-1045. [PMID: 34247163 DOI: 10.1159/000517290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/30/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The primary aim of this study is to compare the efficacy and safety of retrograde intrarenal surgery (RIRS) among the children and adults with similar stone burdens and locations. Also, the secondary aim of this study is to identify the factors affecting the stone-free rates (SFRs) of RIRS. METHODS We retrospectively compared perioperative results, SFRs, and complication rates (CRs) between pediatric (group 1, n: 55) and adult (group 2, n: 220) age groups diagnosed with kidney stones and treated by flexible ureterorenoscopy using the same instruments. Furthermore, multivariate analysis was performed to determine the factors affecting the SFR. RESULTS A total of 275 patients (pediatric group: 55; adult group: 220) were included in this study. The mean age of pediatric and adult groups was 7.2 ± 5.3 and 43.9 ± 15.1, respectively. The mean stone size was 13.9 ± 6.6 mm in the pediatric group compared to 14.8 ± 6.7 mm in the adult group (p = 0.35). Stone localizations and number were similar. JJ stenting for passive dilatation and use of UAS were higher in the pediatric group (p = 0.002; p = 0.017). However, postoperative double pigtail stenting rate was higher in the adult group (p < 0.001). Total CR was 13.8% and mostly Clavien I-II, and no difference was observed between the 2 groups (p = 0.541). The SFRs between the groups were similar (pediatric group: 81.8%; adult group: 78.2%; p = 0.554). On multivariate analysis, stone size (p < 0.001) and lower calyx stone (p < 0.001) were the negative predictive factors for SFR. CONCLUSION There are small technical differences between pediatric patients and adult patients in our study, but RIRS in children is as safe and efficient as it is in adults.
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Affiliation(s)
| | - Mehmet Mesut Piskin
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Balasar
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Yunus Emre Goger
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Giray Sonmez
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
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Zhao FZ, Li J, Tang L, Li CM, Yu Z, Wang WY, Ning C, Tian Y. External Validation of Two Predictive Models for Postoperative Fever After Retrograde Intrarenal Surgery in Pediatric Patients. J Endourol 2021; 35:1135-1139. [PMID: 33528290 DOI: 10.1089/end.2020.0905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study is to validate the efficacy and reliability of two predictive models for postoperative fever after retrograde intrarenal surgery (RIRS) in pediatric patients Materials and Methods: A total of 124 children who were treated with RIRS between August 2014 and August 2020 in our center were included. All the predictors were obtained by preoperative routine examinations. Receiver operative curve (ROC) and area under curve (AUC) were showed to compare the predictive power of the two models. Results: One hundred twenty-four children included of 94 boys and 30 girls, with median ages of 2.1 (1.3, 7.0) years and median body mass index of 17.3 (15.6, 20.6) kg/m2. The total points of the two nomograms were 81.0 (67.3, 90.3) and 45.5 (20.4, 94.0). Eventually, 21 children (16.9%) suffered from postoperative fever. With the exception of C-reactive protein values (25.0 mg/L vs 5.0 mg/L, p = 0.015), irrigation volumes (800 mL vs 500 mL, p = 0.01), and total points of the two predictive models (Nomogram 1: 88.0 vs 76.0, p < 0.001; Nomogram 2: 76.0 vs 39.0, p = 0.016), there was no statistical difference detected between the fever and nonfever groups. ROCs showed that Nomogram 1 presented with better predictive accuracy and efficacy with excellent AUC values of 0.805 in comparison with Nomogram 2 (0.805 vs 0.664, p = 0.025). Conclusion: We reported a sample of 124 children undergoing RIRS with a final stone-free rate of 87.1%. Twenty-one pediatric patients (16.9%) suffered from postoperative fever. Nomogram 1 presented with better predictive power for postoperative fever after RIRS in pediatric patients.
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Affiliation(s)
- Fang-Zhou Zhao
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Jun Li
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Lei Tang
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Chun-Ming Li
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Zhang Yu
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Wen-Ying Wang
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Chen Ning
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Ye Tian
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
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Dogan HS, Asci A, Kahraman O, Gasimov K, Bozaci AC, Tatanis V, Tekgul S. Comparison of Efficiency and Safety of Retrograde Intrarenal Surgery and Micropercutaneous Nephrolithotomy in Pediatric Kidney Stones Smaller than 2 cm: A Prospective Cohort Study. J Endourol 2021; 35:1124-1129. [PMID: 33371783 DOI: 10.1089/end.2020.0624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objective: To compare the safety and efficacy of two minimally invasive surgical techniques used for pediatric stone disease: retrograde intrarenal surgery (RIRS) and micropercutaneous nephrolithotomy (micro-PCNL). Materials and Methods: A prospective study was designed to include children aged <15 years with a single stone <20 mm. Sixty-four patients were assigned to undergo either an RIRS or a micro-PCNL (1:1 ratio). Demographic parameters, stone size, location, operative data, complications, stone-free status, and efficacy quotient were compared. Results: Due to anatomic considerations, seven patients were shifted to the micro-PCNL arm, thus resulting in 39 micro-PCNLs performed vs 25 RIRS in the end. Because of the deviation from planned surgery that was significantly higher in the RIRS group (p = 0.011), the analysis was done in a prospective cohort comparison. Stone-free rates were similar for micro-PCNL and RIRS groups (80% vs 82.2%). The operative (median 60 vs 90 minutes, p < 0.001), fluoroscopy (median 15 vs 30 seconds, p = 0.004), and lithotripsy times (median 15 vs 25 minutes, p = 0.007) were shorter in the RIRS group. However, despite the larger stone size, the efficiency quotient was significantly higher in the micro-PCNL group (82.1% vs 54.1%; p = 0.009). None of the patients experienced significant hematuria requiring blood transfusion, as well as no ureteral orifice obstructive complication was detected within the follow-up period. Conclusion: RIRS and micro-PCNL techniques in children have similar stone-free and complication rates. The operative, fluoroscopy, and lithotripsy times were shorter, deviation from the planned surgery, and the number of sessions under anesthesia was higher in the RIRS group. Despite the larger stone size, efficacy quotient was significantly higher in the micro-PCNL group.
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Affiliation(s)
- Hasan Serkan Dogan
- Department of Urology and Division of Pediatric Urology, Hacettepe University Medical School, Ankara, Turkey
| | - Ahmet Asci
- Department of Urology, Hacettepe University Medical School, Ankara, Turkey
| | - Oguzhan Kahraman
- Department of Urology, Hacettepe University Medical School, Ankara, Turkey
| | - Kamranbay Gasimov
- Department of Urology and Division of Pediatric Urology, Hacettepe University Medical School, Ankara, Turkey
| | - Ali Cansu Bozaci
- Department of Urology and Division of Pediatric Urology, Hacettepe University Medical School, Ankara, Turkey
| | - Vasileios Tatanis
- Department of Urology and Division of Pediatric Urology, Hacettepe University Medical School, Ankara, Turkey
| | - Serdar Tekgul
- Department of Urology and Division of Pediatric Urology, Hacettepe University Medical School, Ankara, Turkey
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Chandramohan V, Siddalingaswamy PM, Ramakrishna P, Soundarya G, Manas B, Hemnath A. Retrograde intrarenal surgery for renal stones in children <5 years of age. INDIAN JOURNAL OF UROLOGY : IJU : JOURNAL OF THE UROLOGICAL SOCIETY OF INDIA 2021; 37:48-53. [PMID: 33850355 PMCID: PMC8033242 DOI: 10.4103/iju.iju_374_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/28/2020] [Accepted: 11/20/2020] [Indexed: 11/04/2022]
Abstract
Introduction There are very few studies in the literature describing retrograde intrarenal surgery (RIRS) in preschool children. We have evaluated the feasibility, stone-free rate, and complications of RIRS in children <5 years of age. Methods All children <5 years of age and stone size <2 cm (renal/proximal ureteric), who underwent RIRS at our hospital from February 2010 to May 2020 were included in this retrospective study. All children were prestented for the passive dilatation of ureter. A 7.5 Fr flexible ureterorenoscope was introduced over the ureteral access sheath (UAS) or over a guidewire. At 2 weeks, the stent was removed and at 2 months the child was evaluated for residual stones. Results A total of 62 children with 67 renal units met the inclusion criteria. The mean age was 42.11 months (4-60 months). Mean weight was 13.31 kg (6-16.3 kg). Mean stone size was 11.9 mm (7.3-18.2 mm). Majority of the stones were in pelvis (37.8%). UAS 9.5/11.5 Fr was placed in 40 (63.5%) children. Mean operative time was 55.2 min; mean hospitalization was 61 h. Four out of the 67 renal units (5.9%) required conversion to minipercutaneous nephrolithotomy in the same sitting, due to access failure. Two cases who developed post-operative fever required a change of antibiotics. Two cases required ureteroscopy for steinstrasse postoperatively. Stone-free rate at 2 months for stones size ≤2 mm was 76.3%. Conclusion Pediatric RIRS is a promising option in young children as it offers acceptable stone-free rates and a low incidence of high-grade complications. However, it requires expertise and should be offered in tertiary care centres.
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Affiliation(s)
- Vaddi Chandramohan
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India
| | - P M Siddalingaswamy
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India
| | - Paidakula Ramakrishna
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India
| | - Ganesan Soundarya
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India
| | - Babu Manas
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India
| | - Anandan Hemnath
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India
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Ather MH, Sulaiman MN. Flexible ureteroscopy versus miniaturized percutaneous nephrolithotomy for renal stones of 1-2 cm. Fac Rev 2020; 9:29. [PMID: 33659961 PMCID: PMC7886059 DOI: 10.12703/r/9-29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Technological advances and innovation in endourology have significantly reduced the indications of extracorporeal shockwave lithotripsy in the management of moderate-sized renal stones. In the last decade, we have witnessed a trend towards the use of finer scopes for percutaneous procedures instead of standard percutaneous nephrolithotomy (PCNL) (≥22 Fr). Miniaturized PCNL (mPCNL), i.e. miniPCNL (12–20 Fr), ultra-miniPCNL (11–13 Fr), mini-microPCNL (8 Fr), and microPCNL (<5 Fr), is increasingly being used. Concomitant developments in laser technology have provided a safe and effective stone fragmentation modality for use via flexible ureteroscopes (fURS). Technological advances in the design of fURS have improved not only the optics (fiber optic to chip-on-the-tip technology digital image) but also the ergonomics. Both the endourological techniques are extremely effective and safe, as shown in a multitude of good-quality studies. There are some differences in stone-free rate and complications. mPCNL in general has a higher stone-free rate, albeit with a slightly higher incidence of hemorrhagic complications. fURS often requires longer stenting time and longer period to achieve stone clearance, whereas mPCNL often needs ureteral catheter for only 24 hours and has a higher first day stone-free rate. fURS is a 1 day procedure compared to mPCNL, which requires patients to stay hospitalized for 2–3 days. It is therefore important to tailor the indications of these two procedures to the individual patient’s needs.
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Affiliation(s)
- M Hammad Ather
- Department of Surgery, Aga Khan University, Karachi, Pakistan
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Zhao FZ, Li J, Tang L, Li CM, Zhang Y, Wang WY, Chen N, Tian Y. Comparison of efficacy and safety of minimally invasive procedures for 10-20 mm pediatric renal Stones-A bayesian network meta-analysis. J Pediatr Urol 2020; 16:771-781. [PMID: 32919900 DOI: 10.1016/j.jpurol.2020.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/19/2020] [Accepted: 08/20/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of various minimally invasive procedures for 10-20 mm pediatric renal stones by Bayesian network meta-analysis (NWA). METHODS We searched clinical comparative trials published in Pubmed, Embase, Cochrane Library from inception to 12 April 2020. Two researchers evaluated the quality and extracted data individually. Data was analyzed using STATA and GEMYC R package. RESULTS The overall network meta-analytic outcome of stone free rate (SFR) in a single session revealed that Retrograde Intrarenal Stone Surgery (RIRS), miniaturized percutaneous nephrolithotomy (mPCNL) and PCNL showed superiority to extracorporeal shockwave lithotripsy (ESWL). Statistical significance was not detected between any intervention from our pooled network analysis of complication rate. SMP was the most likely to ranking in first place to render stone free status, and it also showed the lowest risk possibility of complications. Mini-PCNL had longer operation time and hospitalization than ESWL. The global and loop inconsistency evaluation demonstrated a rather acceptable outcome apart from the comparisons of complication rate between two randomized control studies. DISCUSSION Herein, the authors reviewed and explored the optimal management pattern for pediatric 10-20 mm renal stones. This NWA revealed RIRS and mPCNL could render higher SFR without increasing risk of complications compared with ESWL. Although SMP was deemed to be the best choice in our study, the limited source of study and sample size implied the results required to be further validated. In addition, there were still some problems requiring to be underlined for various surgical options. CONCLUSIONS ESWL was inferior to RIRS, mPCNL and PCNL for 10-20 mm pediatric renal stones, among which SMP might be the most ideal option associated with the least possibility of complications and the highest probability of stone clearance.
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Affiliation(s)
- Fang-Zhou Zhao
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, PR China.
| | - Jun Li
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, PR China.
| | - Lei Tang
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, PR China.
| | - Chun-Ming Li
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, PR China.
| | - Yu Zhang
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, PR China.
| | - Wen-Ying Wang
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, PR China.
| | - Ning Chen
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, PR China.
| | - Ye Tian
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, PR China.
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Imaging modalities and treatment of paediatric upper tract urolithiasis: A systematic review and update on behalf of the EAU urolithiasis guidelines panel. J Pediatr Urol 2020; 16:612-624. [PMID: 32739360 DOI: 10.1016/j.jpurol.2020.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prompt diagnosis and treatment of paediatric urolithiasis are required to avoid long term sequelae of renal damage. OBJECTIVE To systematically review the literature regarding the diagnostic imaging modalities and treatment approaches for paediatric urolithiasis. STUDY DESIGN PubMed, Science Direct, Scopus and Web of Science were systematically searched from January 1980-January 2019. 76 full-text articles were included. RESULTS Ultrasound and Kidney-Ureter-Bladder radiography are the baseline diagnostic examinations. Non-contrast Computed Tomography (CT) is the second line choice with high sensitivity (97-100%) and specificity (96-100%). Magnetic Resonance Urography accounts only for 2% of pediatric stone imaging studies. Expectant management for single, asymptomatic lower pole renal stones is an acceptable initial approach, especially in patients with non-struvite, non-cystine stones<7 mm. Limited studies exist on medical expulsive therapy as off-label treatment. Extracorporeal shock wave lithotripsy (SWL) is the first-line treatment with overall stone free rates (SFRs) of 70-90%, retreatment rates 4-50% and complication rates up to 15%. Semi-rigid ureteroscopy is effective with SFRs of 81-98%, re-treatment rates of 6.3-10% and complication rates of 1.9-23%. Flexible ureteroscopy has shown SFRs of 76-100%, retreatment rates of 0-19% and complication rates of 0-28%. SFRs after first and second-look percutaneous nephrolithotomy (PNL) are 70.1-97.3% and 84.6-97.5%, respectively with an overall complication rate of 20%. Open surgery is seldom used, while laparoscopy is effective for stones refractory to SWL and PNL. Limited data exist for robot-assisted management. CONCLUSIONS In the initial assessment of paediatric urolithiasis, US is recommended as first imaging modality, while non-contrast CT is the second option. SWL is recommended as first line treatment for renal stones <20 mm and for ureteral stones<10 mm. Ureteroscopy is a feasible alternative both for ureteral stones not amenable to SWL as well as for renal stones <20 mm (using flexible). PNL is recommended for renal stones >20 mm.
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Peng L, Wen J, Zhong W, Zeng G. Is physical therapy effective following extracorporeal shockwave lithotripsy and retrograde intrarenal surgery: a meta-analysis and systematic review. BMC Urol 2020; 20:93. [PMID: 32646402 PMCID: PMC7350681 DOI: 10.1186/s12894-020-00664-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/30/2020] [Indexed: 12/21/2022] Open
Abstract
Background Physical therapy, including percussion, inversion, vibration and combinations, was clinically performed to improve the stone free rate (SFR) following lithotripsy procedures. However, physical therapy is not widely accepted in clinical practice owing to lack of high level evidence support and a standard protocol. The present meta-analysis aimed to evaluate the efficacy and safety of physical therapy in improving SFR following extracorporeal shockwave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS). Methods Systematic review of literature from PubMed, Scopus, Cochrane library and Embase was performed in March 2019. The efficacy and safety of physical therapy after ESWL and RIRS were assessed by meta-analysis of SFR and complication rate. Results A total of 8 prospective studies with 1065 patients were enrolled. When compared to non-intervention, physical therapy provided a higher SFR (OR:3.38, 95% CI: 2.45–4.66, p < 0.0001) at all time points (week 1, week 2 and month 1), while there was no significant difference in complications such as hematuria, lumbago, dizziness and urinary tract infection (OR: 0.84; 95%CI: 0.62–1.13; p = 0.237). In subgroup analysis of different stone locations, lower calyx stone (OR: 3.51; 95%CI: 2.21–5.55; p < 0.0001), upper ureter and renal pelvic stones (OR:2.79; 95%CI:1.62–4.81; p = 0.0002) had a higher SFR after physical therapy, while there was no significant improvement in SFR in upper and middle calyx stones. In subgroup analysis of different techniques, EPVL (external physical vibration lithecbole, OR:3.47; 95%CI:2.24–5.37; p < 0.0001) and PDI (percussion, diuresis and inversion, OR:3.24; 95%CI:2.01–5.21; p < 0.0001) were both effective in improving SFR when compared to non-intervention. Conclusions Physical therapy is effective in improving the SFR after ESWL and RIRS, especially for lower calyx stones, upper ureter and renal pelvic stones, while without significant side effects. External physical vibration lithecbole (EPVL) might provide a relative uniformed and repeatable protocol for clinical practice of physical therapy. Trial registration PROSPERO 2019 CRD42019130228.
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Affiliation(s)
- Linjie Peng
- Urology, the First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.,Guangdong Key Laboratory of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.,Guangzhou Institute of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.,Guangzhou Medical University, Guangzhou, China
| | - Junjun Wen
- Urology, the First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.,Guangdong Key Laboratory of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.,Guangzhou Institute of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.,Guangzhou Medical University, Guangzhou, China
| | - Wen Zhong
- Urology, the First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1, Haizhu District, Guangzhou, 510230, China. .,Guangdong Key Laboratory of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China. .,Guangzhou Institute of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
| | - Guohua Zeng
- Urology, the First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1, Haizhu District, Guangzhou, 510230, China. .,Guangdong Key Laboratory of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China. .,Guangzhou Institute of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to describe the options and recent developments in the urologic treatment of nephrolithiasis in children. The prevalence of nephrolithiasis in children has increased over time. The urologic treatment of nephrolithiasis ranges from observation to medical expulsive therapy with an alpha blocker for a stone in a ureter to a variety of procedures for stone removal. RECENT FINDINGS Observation for small, asymptomatic renal stones is a reasonable strategy in children. Medical expulsive therapy with an alpha blocker may have a beneficial effect for passage of ureteral stones in children. Extracorporeal shock wave lithotripsy (ESWL) remains an important treatment for nephrolithiasis in children. Advances in ureteroscopy with clearer digital imaging and single use ureteroscopes have made ureteroscopy more attractive. Percutaneous nephrolithotomy is a more invasive treatment modality but remains a good choice for children with large-stone burdens and instruments are getting smaller. Open or laparoscopic stone surgery should be reserved for unique cases. SUMMARY Nephrolithiasis is increasing in children with differing urologic management options depending on the clinical scenario. A shared decision-making process with discussion of risks and benefits should be used to help patients and families choose a treatment option.
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Sultan S, Aba Umer S, Ahmed B, Naqvi SAA, Rizvi SAH. Update on Surgical Management of Pediatric Urolithiasis. Front Pediatr 2019; 7:252. [PMID: 31334207 PMCID: PMC6616131 DOI: 10.3389/fped.2019.00252] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/03/2019] [Indexed: 12/15/2022] Open
Abstract
Urolithiasis has always been a fascinating disease, even more so in children. There are many intriguing facets to this pathology. This article is a nonsystematic review to provide an update on the surgical management of pediatric urolithiasis. It highlights the pros and cons of various minimally invasive surgical options such as extracorporeal shockwave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), laparoscopy, and robotics. This article also describes the various intracorporeal disintegration technologies available to fragment the stone, including the newer advancements in laser technology. It also emphasizes the cost considerations especially with reference to the emerging economies. Thus, this manuscript guides how to select the least-invasive option for an individual patient, considering age and gender; stone size, location, and composition; and facilities and expertise available.
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Affiliation(s)
- Sajid Sultan
- Philip G. Ransley Department of Paediatric Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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