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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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Carmen Tong CM, Ellison JS, Tasian GE. Pediatric Stone Disease: Current Trends and Future Directions. Urol Clin North Am 2023; 50:465-475. [PMID: 37385708 DOI: 10.1016/j.ucl.2023.04.009] [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: 07/01/2023]
Abstract
Pediatric nephrolithiasis is less common in children than in adults but the incidence has been rising rapidly, and it is now a public health and economic burden in the United States. There are challenges unique to children that should be taken into consideration when evaluating and managing pediatric stone disease. In this review, we present the current research on risk factors, emerging new technologies for treatment of stones and recent investigations on prevention of stones in this population.
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Affiliation(s)
- Ching Man Carmen Tong
- Department of Pediatric Urology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Suite 318, Birmingham, AL 35233, USA.
| | - Jonathan S Ellison
- Department of Urology, Medical College of Wisconsin, Children's Hospital of Wisconsin and Medical College of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Gregory E Tasian
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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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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Soltani MH, Karimi A, Salimi M, Amini E. Feasibility, safety, and effectiveness of adult-sized instruments in pediatric percutaneous nephrolithotomy: A systematic review and meta-analysis. J Pediatr Urol 2022; 18:303-310. [PMID: 35534382 DOI: 10.1016/j.jpurol.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/25/2022] [Accepted: 04/15/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Little evidence exists regarding the benefits and disadvantages of adult-sized instruments for Percutaneous Nephrolithotomy (PCNL) in pediatric patients. This systematic review aims to clarify the safety and efficacy of this approach. MATERIALS AND METHODS We conducted a systematic literature review using databases of PubMed, Scopus, Embase, Web of Science, and Cochrane and included studies that evaluated PCNL in children. All identified records underwent two-phase title/abstract and full-text screening. Pediatric patients were defined as 17 years or younger, and adult-sized instruments as 24Fr and above. The primary outcomes were success (stone-free) rate and surgical complications obtained from studies comparing adult-sized and pediatric-sized instruments. RESULTS A total of 84 abstracts and 16 full text article were assessed till July 2021 and 6 studies were included. All studies were retrospective. Number of accesses (Odds ratio (OR), adult-sized to pediatric-sized: 0.96, 95% CI: 0.52-1.78, p = 0.89), initial stone-free rate (OR: 0.73, 95% CI: 0.42-1.27, p = 0.26), final stone-free rate (OR: 1.14, 95% CI: 0.38-3.44, p = 0.82), and residual stones (OR: 0.79, 95% CI: 0.42-1.49, p = 0.46) could be analyzed, none with significant differences. Overall complication rates did not differ significantly between the groups. However, one study reported more grade III/IV complications in the adult-sized instrument group. The adult-sized instrument group had a higher hemoglobin/hematocrit decrease in 3 studies. Duration of surgery, fluoroscopy time, length of hospital stay, times to nephrostomy tube removal, and transfusion rate could not be assessed in meta-analysis; however, they were comparable between the adult-sized and pediatric-sized groups. Studies also showed that adult-sized instruments are applicable in children younger than 3 years and those with staghorn calculi as well as in fluoroscopy-free ultrasound-guided PCNL. CONCLUSION Adult-sized instruments had comparable outcomes to the pediatric-sized ones and can be applied in pediatric PCNL when factors such as accessibility justify their use. The number and design of the studies restrict the reliability of the comparisons. Therefore, future studies with improved methodology may better reveal the impact of instruments on the outcome of PCNL in children.
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Affiliation(s)
- Mohamamd Hossein Soltani
- Shahid Labbafinejad Hospital, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirali Karimi
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maziar Salimi
- Shahid Labbafinejad Hospital, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erfan Amini
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Simayi A, Lei P, Tayier T, Aimaier A, Xiao'an Z, Alimu Y. Comparison of super-mini versus mini percutaneous nephrolithotomy for the treatment of upper urinary tract stones in children: a single centre experience. Pediatr Surg Int 2021; 37:1141-1146. [PMID: 34021402 DOI: 10.1007/s00383-021-04925-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE The efficacy and safety of super-mini percutaneous nephrolithotomy (SMP, 14 Fr) was compared with mini percutaneous nephrolithotomy (MPCNL, 16 Fr) for the treatment of upper urinary tract stones in children (< 14 years old). METHODS Clinical data of 133 paediatric patients with upper urinary tract stones treated with SMP or MPCNL between May 2012 and May 2019 were retrospectively analysed. The patients were divided into the SMP and MPCNL groups. Age, height, weight, stone size, operation time, stone-free rate (SFR), postoperative complications, tubeless rate, and length of postoperative hospital stay (LOS) were compared. RESULTS There were 66 patients (49.6%) in the SMP and 67 patients (50.4%) in the MPCNL group. No significant difference in the median age, weight, height and operation time, and SFR existed between the patients of the two groups. Larger stones were removed via SMP compared to those removed with MPCNL (2.0 vs. 1.5 cm, P = 0.001). LOS for SMP patients was significantly lower than that for the MPCNL patients (2 and 6 days, respectively, P < 0.0001). The tubeless rate for SMP was significantly higher than that for MPCNL (100% vs. 0%, P < 0.0001). Total complication rate of MPCNL was significantly higher than that of SMP (25.3% vs. 7.5%, P = 0.006). No patient required blood transfusion, and septicaemia, and other serious complications did not occur. CONCLUSION SMP is more effective than MPCNL for treating middle-sized upper urinary tract stones in children, and is associated with a shorter LOS and a higher tubeless rate.
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Affiliation(s)
- Abulizi Simayi
- Urology Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Peng Lei
- Urology Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
| | - Talaiti Tayier
- Urology Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Aihemaiti Aimaier
- Urology Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Zhang Xiao'an
- Urology Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Yalikun Alimu
- Urology Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 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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Effects of the stone density on the outcome of percutaneous nephrolithotomy in pediatric population. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.587965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fan BY, Gu L, Chand H, Liu WJ, Yuan JB. Mini-percutaneous nephrolithotomy for pediatric complex renal calculus disease: one-stage or two-stage? Int Urol Nephrol 2018; 51:201-206. [PMID: 30542945 DOI: 10.1007/s11255-018-2054-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/07/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare two different treatment strategies, one-stage and two-stage multi-tract mini-percutaneous nephrolithotomy (mt-mPCNL), for pediatric complex renal calculus disease. METHODS Between the period of July 2016 and July 2018, a total of 36 children aged 15 years and younger, with complex renal calculi disease, who underwent total ultrasound-guided mt-mPCNL by a single experienced urologist were enrolled in our study. All patients were assigned either to Group 1 (n = 18) who received one-stage mt-mPCNL or Group 2 (n = 18) who received planned two-stage mt-mPCNL. RESULTS The demographic data were comparable between the two groups. There were no serious complications (Modified Clavien Grade ≥ III) observed in either group. The stone -free rate (SFR), operation time, postoperative creatinine increase, and perioperative complication rates were similar in both groups (P = 0.603, 0.818, 0.161, and 0.402, respectively). The postoperative hospital stay (5.8 days vs. 7.4 days) and cost (17373.3 CNY vs. 23717.1 CNY) were statistically less in Group 1. Group 2 had significantly less total estimated blood loss (70.6 ml vs. 130.0 ml, P < 0.001). The operation time of two cases in Group 1 with perioperative sepsis or systemic inflammatory response syndrome (SIRS) was more than two hours. CONCLUSIONS Our preliminary results indicated that both one-stage and two-stage mt-mPCNL were safe and effective for pediatric complex renal calculi. Two-stage mt-mPCNL could significantly reduce blood loss; while one-stage mt-mPCNL could significantly decrease the length and costs of hospitalization. We also suggest that the planned two-stage mt-mPCNL should be applied in children with estimated operation time more than two hours.
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Affiliation(s)
- Ben-Yi Fan
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Lan Gu
- Department of Blood Transfusion, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Harripersaud Chand
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Wen-Jun Liu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Jun-Bin Yuan
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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Clinical application of super-mini PCNL (SMP) in the treatment of upper urinary tract stones under ultrasound guidance. World J Urol 2018; 37:943-950. [PMID: 30167833 DOI: 10.1007/s00345-018-2465-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To present the safety and efficacy of totally ultrasonography-guided Super-mini percutaneous nephrolithotomy (SMP) in the treatment of upper urinary tract stones both in children and adults. PATIENTS AND METHODS We carried out SMP in 104 patients (including 48 children and 56 adults) with upper urinary tract stones between June 2015 and February 2017. All steps of renal access were performed by ultrasonography. The lithotripsy was performed using either Holmium laser or pneumatic lithotripter. Perioperative and postoperative parameters along with operative data were recorded in detail. RESULTS The mean age of children and adult patients were 4.4 ± 3.6 and 44.3 ± 15.7 years old, respectively. The stone burden was comparable for both groups (1.72 ± 0.66 vs 1.74 ± 0.56 cm, p = 0.852). Mean operation time was not significant different between two groups (p = 0.052), while the mean haemoglobin drop in children was much lower in adult patients (6.3 ± 6.9 vs 10.9 ± 8.69, p = 0.004). Both groups had similar SFRs in postoperative 1 day and at 1-month follow-up (p = 1.000, p = 0.912). Mean hospital stay of children and adult patients was 2.3 ± 0.8 and 2.2 ± 0.76 days (p = 0.484). The total complication rate was significantly lower in two groups (p = 1.000); none of the patients required blood transfusion. CONCLUSIONS Ultrasonography-guided SMP was a safe and effective treatment option for moderate-sized upper urinary tract stones, and has the advantage of preventing radiation hazard, especially for pediatric stone patients.
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Ellison JS, Yonekawa K. Recent Advances in the Evaluation, Medical, and Surgical Management of Pediatric Nephrolithiasis. CURRENT PEDIATRICS REPORTS 2018. [DOI: 10.1007/s40124-018-0176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nouralizadeh A, Sharifiaghdas F, Pakmanesh H, Basiri A, Radfar MH, Soltani MH, Nasiri M, Maleki ER, Lesha E, Ghasemi-Rad M, Narouie B. Fluoroscopy-free ultrasonography-guided percutaneous nephrolithotomy in pediatric patients: a single-center experience. World J Urol 2018; 36:667-671. [PMID: 29349571 DOI: 10.1007/s00345-018-2184-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 01/09/2018] [Indexed: 12/18/2022] Open
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