Comparison of efficacy and safety of minimally invasive procedures for 10-20 mm pediatric renal Stones-A bayesian network meta-analysis

Efficacy of mini-endoscopic combined intrarenal surgery for pediatric kidney calculi: a single center retrospective study

Management of large pediatric kidney calculi (PKC) is challenging. This study aimed to evaluate the efficacy and safety of miniature endoscopic combined intrarenal surgery (mini-ECIRS) for PKC. We retrospectively analyzed mini-ECIRS in 16 pediatric patients undergoing kidney stone treatment between November 2014 and October 2023 to determine its safety, efficacy, and associated outcomes. The median age was 50.50 (interquartile range: 36.75, 84.75) months, and the mean stone size was 21.63 ± 11.65 mm. The stone-free rate was 81.25%. The median decrease in hemoglobin level on the day after surgery was 1.10 (0.80, 1.55), and no patient required a blood transfusion. The median number of general anesthesia procedures was 2.00 (2.00, 2.00). Postoperative complications included fever in two patients and difficulty in removing the ureteral stent in one patient. In this cohort, five patients underwent pre-stenting under general anesthesia before mini-ECIRS. Age was significantly lower in the pre-stenting group than in the non-pre-stenting (P < 0.01); however, there were no significant differences in operative time, stone-free rate, total number of general anesthesia procedures, hemoglobin loss, or postoperative hospital stay between the groups. Mini-ECIRS was found to be a safe and efficient treatment method with a high stone removal rate in pediatric patients.

Paediatric percutaneous nephrolithotomy (P-PCNL) reporting checklist

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.

The technological future of percutaneous nephrolithotomy: a Young Academic Urologists Endourology and Urolithiasis Working Group update

PURPOSE OF REVIEW

With advancements in surgical technology along with procedural techniques, this article throws light on the latest developments and applications of artificial intelligence (AI), extended reality, 3D (three-dimensional) printing and robotics in percutaneous nephrolithotomy (PCNL).

RECENT FINDINGS

This review highlights the applications of AI in PCNL over the past 2 years. Mostly studies have been reported on development of machine learning (ML) based predicting models and identification of stone composition using deep learning convolutional neural network (DL-CNN). But owing to the complexity of the models and lack of generalizability, it is still not incorporated in the routine clinical practice. Extended reality based simulation and training models have enabled trainees to enhance their skills and shorten the learning curve. Similar advantages have been reported with the use of 3D printed models when used to train young and novice endourologists to improve their skills in percutaneous access (PCA). Applications of robotics in PCNL look promising but are still in nascent stages.

SUMMARY

Future research on PCNL should focus more on generalizability and adaptability of technological advancements in terms of training and improvement of patient outcomes.

A meta-analysis: retrograde intrarenal surgery vs. percutaneous nephrolithotomy in children

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.

Retrograde Intrarenal Surgery in Children: Evolution, Current Status, and Future Trends

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.

The Ascent of Artificial Intelligence in Endourology: a Systematic Review Over the Last 2 Decades

Purpose of Review

To highlight and review the application of artificial intelligence (AI) in kidney stone disease (KSD) for diagnostics, predicting procedural outcomes, stone passage, and recurrence rates. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist.

Recent Findings

This review discusses the newer advancements in AI-driven management strategies, which holds great promise to provide an essential step for personalized patient care and improved decision making. AI has been used in all areas of KSD including diagnosis, for predicting treatment suitability and success, basic science, quality of life (QOL), and recurrence of stone disease. However, it is still a research-based tool and is not used universally in clinical practice. This could be due to a lack of data infrastructure needed to train the algorithms, wider applicability in all groups of patients, complexity of its use and cost involved with it.

Summary

The constantly evolving literature and future research should focus more on QOL and the cost of KSD treatment and develop evidence-based AI algorithms that can be used universally, to guide urologists in the management of stone disease.

Comparison of mini-PCNL and retrograde intrarenal surgery in the treatment of kidney stone over 50 years old patients

Mini-Percutaneous Nephrolithotomy (M-PCNL) and Retrograde Intrarenal Surgery (RIRS) are commonly used methods in treatment of kidney stones. The aim of our study is to compare the efficacy and safety of M-PCNL and RIRS in kidney stone treatment over 50 years old patients. A total of 125 patients, 65 of whom had RIRS, and 60 of whom had M-PCNL, were included in the study. Age, gender, BMI (Body-Mass Index), ASA (American Society of Anesthesiology) scores of the patients; stone size, stone location, operation side, ESWL history, HU (Hounsfield Unit) values, hospital stay durations, SFR, complication rates according to Clavien modification system, postoperative hemoglobin loss, postoperative transfusion rates, and patients who needed a secondary operation were recorded. SFR values were calculated in the postoperative third and sixth months. The data between the two groups had similar characteristics in terms of age, gender, BMI, HU, stone size, operation side, stone location, ESWL history, operation time, postoperative transfusion rate, postoperative Clavien complications (p > 0.05). When the ASA categories were evaluated, the mean ASA scores, ASA I, and ASA II data had similar characteristics in both groups (p > 0.05). When the ASA 3 scores were evaluated, the number of ASA III patients in the RIRS group was statistically significantly higher (p < 0.05). When hospital stay duration and postoperative hemoglobin loss were examined, RIRS group was found to be advantageous (p < 0.05). Postoperative third month SFR and Postoperative sixth month values were statistically significantly higher in M-PCNL group (p < 0.05). M-PCNL and RIRS are methods that can be used safely and effectively over 50 years old patients in kidney stone surgery. M-PCNL has been found to be more advantageous in terms of SFR rates and as it requires less secondary intervention. RIRS is advantageous in terms of short hospital stay, postoperative hemoglobin loss, and applicability to patients who are not suitable for the prone position.