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Güzel R, Yildirim Ü, Sarica K. Contemporary minimal invasıve surgical management of stones in children. Asian J Urol 2023. [PMID: 37538162 PMCID: PMC10394283 DOI: 10.1016/j.ajur.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Objective Pediatric urolithiasis has been more common over the past 20 years, and urologists have unique challenges in managing it surgically because this particular demographic is recognized as one of the high-risk categories for stone recurrence. Given this reality, care focuses on maintaining renal function, achieving total stone-free status, and most importantly avoiding stone recurrences. In this presented article, we aimed to make a comprehensive review of the current minimally invasive treatment of pediatric kidney stone disease. Methods We evaluated the results of 74 studies following a comprehensive PubMed search till February 2023. This article was written by making use of current urology guidelines. Results Considering the reported occurrence of metabolic issues in up to 50% of cases in addition to the anatomic anomalies (about 30% of cases), the treatment of pediatric urolithiasis necessitates a full metabolic and urological examination on an individual basis. Timely management of metabolic imbalances and obstructive diseases is necessary. In addition to encouraging proper fluid consumption, it is advisable to improve urine volume and consider using medical therapeutics to raise urinary citrate levels. The location, content, and size of the stone(s), the morphology of the collecting system, the presence of urinary tract infection, as well as the presence of any obstruction, should all be taken into consideration while deciding on the best surgical procedure. Conclusion All modern endourological methods are now used in the safe and efficient care of pediatric urolithiasis as a consequence of the obvious advancements in instrument technology and expanding expertise derived from adult patients. Other minimally invasive procedures, such as ureterorenoscopy and percutaneous nephrolithotomy, require more expertise and can be successfully applied with careful management for an excellent stone-free rate with minimal morbidity. Of these procedures, shock wave lithotripsy is still the first choice in the majority of cases with upper tract calculi. Open surgery will still be the therapy of choice for pediatric patients with complicated and big stones as well as anatomical anomalies.
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Topaktas R, Aydin C, Altin S, Akkoc A, Aydın ZB, Urkmez A. The Efficacy of Ultra-thin Semi-rigid Ureteroscopy with Holmium Laser Lithotripsy in Pediatric Ureteral Stones: A Single-center Experience. Cureus 2019; 11:e5496. [PMID: 31667032 PMCID: PMC6816524 DOI: 10.7759/cureus.5496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The aim of this study was to present our results regarding the feasibility and possible complications of 4.5 Fr semi-rigid ureterorenoscopy (URS) treatments in pediatric patients. Methods The files and computer records of a total of 33 pediatric patients (20 males and 13 females), who underwent URS procedures for ureteral stones > 5 mm between January 2013 and June 2017, were retrospectively reviewed. A 4.5 Fr semi-rigid ureteroscope (Ultrathin 4.5/6.5 Fr Ureterorenoscope; Richard Wolf GmbH, Knittlingen, Germany) was used for the URS procedures. For the stone-free rate evaluations, abdominopelvic ultrasound or direct radiography scans were performed one week after the surgery, and low-dose non-contrast computed tomography (CT) was performed during the first month. Results The mean age of the patients was 9.8 ± 2.8 (range 4-16) years old, and the mean ureteral stone size was 8.9 ± 1.4 (range 6-13) mm. The mean surgical duration was 45 ± 21.2 (range 30-75) minutes, and the mean hospital stay length was 1.2 (range 1-4) days. Minor complications occurred in five (15.1%) of the patients. The success rates for the first week and first month were 90.9% and 96.9%, respectively. Conclusion The endoscopic management of pediatric ureteral stones using a 4.5 Fr ureteroscope seems to be a safe and feasible treatment option with high success and low complication rates.
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Affiliation(s)
- Ramazan Topaktas
- Urology, Haydarpasa Numune Training and Research Hospital, Istanbul, TUR
| | - Cemil Aydin
- Urology, Hitit University Erol Olcok Training and Research Hospital, Corum, TUR
| | - Selcuk Altin
- Urology, Necip Fazıl Training and Research Hospital, Kahramanmaras, TUR
| | - Ali Akkoc
- Urology, Alanya Alaaddin Keykubat University, Antalya, TUR
| | - Zeynep B Aydın
- Radiology, Hitit University Erol Olcok Training and Research Hospital, Çorum, TUR
| | - Ahmet Urkmez
- Urology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR
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Kirac M, Ergin G, Kibar Y, Köprü B, Biri H. The Efficacy of Ureteroscopy Without Fluoroscopy for Ureteral and Renal Stones in Pediatric Patients. J Endourol 2018; 32:100-105. [DOI: 10.1089/end.2017.0593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mustafa Kirac
- Department of Urology, Koru Ankara Hospital, Ankara, Turkey
| | - Giray Ergin
- Department of Urology, Koru Ankara Hospital, Ankara, Turkey
| | - Yusuf Kibar
- Department of Urology, Koru Ankara Hospital, Ankara, Turkey
| | - Burak Köprü
- Department of Urology, Koru Ankara Hospital, Ankara, Turkey
| | - Hasan Biri
- Department of Urology, Koru Ankara Hospital, Ankara, Turkey
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Abstract
There are several special situations in which urinary lithiasis presents management challenges to the urologist. An in-depth knowledge of the pathophysiology, unique anatomy, and treatment options is crucial in order to maintain good health in these patients. In this review, we summarize the current literature on the management of the following scenarios: bladder stones, stones in bowel disease, during pregnancy, in association with renal anomalies, with skeletal deformities, in urinary diversions, and in children.
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Application of Pneumatic Lithotripter and Holmium Laser in the Treatment of Ureteral Stones and Kidney Stones in Children. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2505034. [PMID: 28299318 PMCID: PMC5337338 DOI: 10.1155/2017/2505034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/29/2017] [Indexed: 11/20/2022]
Abstract
Objective. Treatment options for urolithiasis in children include URSL and RIRS. Various types of energy are used in the disintegration of deposits in these procedures. We decided to evaluate the usefulness of URSL and RIRS techniques and compare the effectiveness of pneumatic lithotripters and holmium lasers in the child population based on our experience. Materials and Methods. One hundred eight (108) children who underwent URSL and RIRS procedures were enrolled in the study and divided into two (2) groups according to the type of energy used: pneumatic lithotripter versus holmium laser. We evaluated the procedures' duration and effectiveness according to the stone-free rate (SFR) directly after the procedure and after fourteen (14) days and the rate of complications. Results. The mean operative time was shorter in the holmium laser group. A higher SFR was observed in the holmium laser but it was not statistically significant in the URSL and RIRS procedures. The rate of complications was similar in both groups. Conclusions. The URSL and RIRS procedures are highly efficient and safe methods. The use of a holmium laser reduces the duration of the procedure and increases its effectiveness in comparison with the use of a pneumatic lithotripter.
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Sarica K, Sahin C. Contemporary Minimally Invasive Surgical Management of Urinary Stones in Children. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.eursup.2016.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Dangle PP, Bandari J, Lyon TD, Lee A, Ayyash O, Cannon GM, Schneck FX, Stephany HA, Ost MC. Outcomes of Ureteroscopic Management of Pediatric Urolithiasis: A Comparative Analysis of Prepubertal and Adolescent Patients. Urology 2016; 89:103-6. [PMID: 26747677 DOI: 10.1016/j.urology.2015.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 11/25/2015] [Accepted: 12/15/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the outcomes of ureteroscopic intervention in terms of both the stone-free rate and complications in both prepubertal and adolescent patients. Although safety of pediatric ureteroscopic intervention is well established, a comparative outcome of prepubertal and adolescent patients is lacking. MATERIALS AND METHODS Pediatric patients who underwent ureteroscopic treatment of a renal or ureteral stone at our institution from July 2005 to August 2014 were retrospectively identified. Patients were classified by age either as prepubertal (≤11 years) or adolescent (>11 years) for purposes of comparison. Demographic and intraoperative variables as well as 30-day postoperative complication rates were compared between groups. Data were analyzed using χ(2) and Fisher's exact tests as appropriate. RESULTS A total of 104 patients were identified, of whom 64 (62%) were prepubertal and 40 (38%) were adolescent. Ureteroscopic failure occurred in a minority of patients (5% vs 4.7%, P > .9). Complication rates including ureteral perforation (0% vs 1.6%, P > .9), postoperative urinary tract infection (2.5% vs 4.7%, P > .9), hematuria with clot passage (0% vs 7.8%, P = .15), and persistent flank pain (15% vs 17%, P = .85) were not significantly different between adolescent and prepubertal patients, respectively. CONCLUSION In spite of small size and small body habitus, the ureteroscopic management of pediatric urolithiasis can be performed successfully in both the prepubertal and adolescent patients with acceptable and equivalent morbidity as well as successful clearance of stone.
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Affiliation(s)
- Pankaj P Dangle
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, PA.
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh, Pittsburgh, PA
| | - Timothy D Lyon
- Department of Urology, University of Pittsburgh, Pittsburgh, PA
| | - Andy Lee
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Omar Ayyash
- Department of Urology, University of Pittsburgh, Pittsburgh, PA
| | - Glenn M Cannon
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Francis X Schneck
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Heidi A Stephany
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Michael C Ost
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, PA
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Tondut L, Peyronnet B, Arnaud A, Freton L, Hascoet J, Pradère B, Berquet G, Habonimana E, Verhoest G, Azzis O, Fremond B, Bensalah K. [Impact of the acquisition of a flexible ureteroscope on the management of upper urinary tract stones in children]. Prog Urol 2015; 26:96-102. [PMID: 26681576 DOI: 10.1016/j.purol.2015.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 10/27/2015] [Accepted: 10/31/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Firstly reported in the early 1990s for the treatment of upper urinary tract stones in adult patients, flexible ureteroscopy (F-URS) has been used in children during the past 10 years and is now considered as a viable, but still second-line alternative to extracorporeal shockwave lithotripsy in these patients (ESWL). The aim of this study was to assess the impact of the acquisition of a F-URS on the management of upper urinary tract stones in children. PATIENTS AND METHODS Data of all ESWL, F-URS and percutaneous nephrolithotomy performed for upper urinary tract stones in children from 0 to 18 years old in a single center from 2000 to 2014 have been collected retrospectively. Patients have been divided into two groups: group 1 before the acquisition of the F-URS (2000-2008) and group 2 after the acquisition of the F-URS (2008-2014). Preoperative data and peri-operative outcomes were compared between both groups using the χ(2) test and Fisher exact test for discrete variables and the Mann-Whitney test for continuous variables. RESULTS Thirty-seven children have been treated during the first era and 32 during the second one. The two groups were similar in terms of age (7.2 years vs 8.1 years; P=0.54), size of the largest stone (15 mm vs 16.2mm; P=0,56) and number of stones per patient (1.4 vs 2; P=0,07) but the sum of stone diameters was higher in group 2 (16.9 mm vs 24.2mm; P=0,048). The stone-free rates were comparable in both groups (28.1% vs 32.2% after the first procedure; P=0.72), as were the mean number of procedures per patient (2.4 vs 2.5; P=0.78), the total length of stay (2.7 days vs 2.9 days; P=0.77), and the number of patients who experienced at least one complication (37.8% vs 40.6%; P=0.87). CONCLUSION The acquisition of a F-URS allowed the treatment of more complex stones with a similar efficacy and without increasing morbidity. Further studies are needed to define the role of F-URS in the management of upper urinary tract stones in children.
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Affiliation(s)
- L Tondut
- Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
| | - B Peyronnet
- Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - A Arnaud
- Service de chirurgie pédiatrique, CHU de Rennes, 35000 Rennes, France
| | - L Freton
- Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - J Hascoet
- Service de chirurgie pédiatrique, CHU de Rennes, 35000 Rennes, France
| | - B Pradère
- Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - G Berquet
- Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - E Habonimana
- Service de chirurgie pédiatrique, CHU de Rennes, 35000 Rennes, France
| | - G Verhoest
- Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - O Azzis
- Service de chirurgie pédiatrique, CHU de Rennes, 35000 Rennes, France
| | - B Fremond
- Service de chirurgie pédiatrique, CHU de Rennes, 35000 Rennes, France
| | - K Bensalah
- Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
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Affiliation(s)
- Paul Erotocritou
- Stone Unit, University College London Hospitals Foundation NHS Trust, UK
| | - Naima Smeulders
- Department of Urology, Great Ormond St Hospital for Children NHS Foundation Trust, UK
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11
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Retrograde intrarenal surgery for the treatment of renal stones in children: factors influencing stone clearance and complications. J Pediatr Surg 2014; 49:1161-5. [PMID: 24952809 DOI: 10.1016/j.jpedsurg.2013.12.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 12/09/2013] [Accepted: 12/11/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Retrograde intrarenal surgery (RIRS) is a known option for the treatment of upper tract calculi with an excellent success. However, the reports of RIRS in prepubertal children are limited. In this study, we evaluated the factors which affected the success rate and the complications of RIRS at renal stone treatment in childhood. METHODS We retrospectively reviewed the records of children under 14 years old who underwent RIRS for renal stone disease between January 2009 and December 2012. Patients' age, gender, body mass index (BMI), stone size, stone location, stone number, intraoperative complications, stone free status, postoperative complications were recorded. RESULTS There were 80 ureterorenoscopic procedures performed in 58 renal units of 47 children (23 males and 24 females). The patients' ages ranged from 8 months to 14 years (mean age 4.7 ± 3.4 years). There was a difference in the distribution of symptoms in age groups. UTI was higher in the 1-4 years age group, abdominal pain was seen mostly in children aged 5-14 years. Multiple stones (included staghorn stone) were noted in 60.4% of patients. In 27.6% of patients, ureteral stones were accompanied by renal stones in our series. In the infancy group, cystine and staghorn stones were more frequently seen, mostly bilateral. After a single ureteroscopic procedure for intrarenal stones in children, we achieved stone free status in 50.9% of the ureters (n=26). After the repeated sessions, the stone clearance rate reached to 85.1%. CONCLUSION Retrograde intrarenal surgery can be used as a first line therapy to treat renal stones in children. This is especially important if an associated ureteral stone is present that requires treatment; or in patients with cystinuria, which is not favorably treated with ESWL. Complications were seen more frequently in patients with cystine stones. Extravasation was noted more frequently in patients admitted with UTIs. There was a significant relationship between the conversion to open procedures and the age groups, with most procedures occurring in infancy. The parents should be informed about the probability of multiple procedures to achieve stone free status.
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Porpiglia F, Fiori C, Poggio M, Cossu M, Amparore D, Manfredi M, Bertolo R, Mele F, Garrou D, Cattaneo G, Scarpa RM. [Ureteroscopy: is it the best?]. Urologia 2014; 81:99-107. [PMID: 24915150 DOI: 10.5301/uro.5000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2014] [Indexed: 11/20/2022]
Abstract
Over the last 40 years the treatment of urolithiasis passed from open surgical therapies to minimally invasive approaches. From the introduction of the first ureteroscopes in '80s many technological improvements allowed to reduce endourological instruments' size, ensuring in the meanwhile an increasingly high success rate in the resolution of the urolithiasis. The purpose of the study is to review the current role of the ureteroscopy(URS) in the treatment of urinary stones. A non-systematic review was performed considering the most recent Guidelines and results from Literature. The results confirm that, considering ureteral calculi, the stone-free rate (SFR) for URS is significantly higher than for ESWL in the treatment of distal ureteral stones <10 mm and >10 mm. Endoscopy has a first-line role also in the treatment of proximal ureteral stones >10 mm, together with ESWL. Retreatment rate and ancillary procedures are also lower in patients treated with URS, despite it is more invasive if compared with ESWL. Recent data are available in Literature about the treatment of nephrolithiasis with Retrograde Intra-Renal Surgery (RIRS). RIRS is the first-line treatment, together with ESWL, for stones <20 mm, and second choice for stones >20 mm. However, for large renal stones the role of RIRS is still being discussed. In conclusion, the majority of urinary stones can be treated by rigid or flexible URS. Further studies are required to clarify the role of endoscopy in the treatment of large stones, especially if compared to percutaneous approaches.
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Affiliation(s)
- Francesco Porpiglia
- Divisione di Urologia, Dipartimento di Oncologia, Ospedale San Luigi Gonzaga, Orbassano (TO) - Italy
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Mokhless IA, Abdeldaeim HM, Saad A, Zahran AR. Retrograde intrarenal surgery monotherapy versus shock wave lithotripsy for stones 10 to 20 mm in preschool children: a prospective, randomized study. J Urol 2014; 191:1496-9. [PMID: 24679882 DOI: 10.1016/j.juro.2013.08.079] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE We compared the outcome of retrograde intrarenal surgery monotherapy vs shock wave lithotripsy for stones 10 to 20 mm in preschool children. MATERIALS AND METHODS This prospective study included 60 children with a mean ± SD age of 2.4 ± 1.3 years. Patients were randomly divided into 2 groups. Group 1 underwent shock wave lithotripsy and group 2 underwent retrograde intrarenal surgery as monotherapy. Retrograde intrarenal surgery was started using a 7.5Fr semirigid ureteroscope (Storz®) and the holmium laser, and completed by the Flex X™2 flexible ureterorenoscope. A ureteral access sheath was not used and only hydrodilatation was performed. Patients were evaluated preoperatively by ultrasound and plain abdominopelvic x-ray. Followup was 3 months. RESULTS The stone-free rate after a single session treatment was 70% and 86.6% in groups 1 and 2, respectively. Mean operative time was 27.9 ± 3.5 and 40 ± 7.8 minutes, mean fluoroscopy exposure time was 60 ± 42 and 50 ± 35 seconds, and mean hospital stay was 6 ± 2 and 12 ± 8 hours, respectively. No major complication occurred in either group and no child in either group received blood transfusion. Nine group 1 patients needed a second shock wave lithotripsy session, of whom 2 required a third session. At 3 months the overall stone-free rate was 93.3% and 96.6% in groups 1 and 2, respectively. CONCLUSIONS Retrograde intrarenal surgery is an option for treating medium sized renal stones in preschool children with results comparable to those of shock wave lithotripsy and a safe short-term outcome.
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Affiliation(s)
| | | | - Ashraf Saad
- Urology Department, Alexandria University, Alexandria, Egypt
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Aydogdu O, Karakose A, Celik O, Atesci YZ. Recent management of urinary stone disease in a pediatric population. World J Clin Pediatr 2014; 3:1-5. [PMID: 25254178 PMCID: PMC4145644 DOI: 10.5409/wjcp.v3.i1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 12/27/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
The incidence of stone disease has been increasing and the risk of recurrent stone formation is high in a pediatric population. It is crucial to use the most effective method with the primary goal of complete stone removal to prevent recurrence from residual fragments. While extracorporeal shock wave lithotripsy (ESWL) is still considered first line therapy in many clinics for urinary tract stones in children, endoscopic techniques are widely preferred due to miniaturization of instruments and evolution of surgical techniques. The standard procedures to treat urinary stone disease in children are the same as those used in an adult population. These include ESWL, ureterorenoscopy, percutaneous nephrolithotomy (standard PCNL or mini-perc), laparoscopic and open surgery. ESWL is currently the procedure of choice for treating most upper urinary tract calculi in a pediatric population. In recent years, endourological management of pediatric urinary stone disease is preferred in many centers with increasing experience in endourological techniques and decreasing sizes of surgical equipment. The management of pediatric stone disease has evolved with improvements in the technique and a decrease in the size of surgical instruments. Recently, endoscopic methods have been safely and effectively used in children with minor complications. In this review, we aim to summarize the recent management of urolithiasis in children.
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Jurkiewicz B, Ząbkowski T, Samotyjek J. Ureterolithotripsy in a paediatric population: a single institution's experience. Urolithiasis 2013; 42:171-6. [PMID: 24368682 DOI: 10.1007/s00240-013-0634-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 12/16/2013] [Indexed: 11/30/2022]
Abstract
This study presents one institution's experiences in ureterolithotripsy (URSL)--a particular endoscopic treatment modality. The incidence and prevalence of urolithiasis in the paediatric population continues to increase. However, the choice of the most appropriate treatment remains a challenging problem for paediatric surgeons. Between January 2006 and June 2013, the Department of Pediatric Surgery performed 157 URSLs. The patient population consisted of 126 children (60 girls and 66 boys) aged 10 months-17 years and having a body mass >8 kg. Dilatation of the pyelocalyceal system along with dilatation of the ureter above the concrement was present in all patients. Pneumatic, laser (Ho:YAG--pulsed laser), ultrasonic lithotripters with rigid, flexible ureteroscopes of 4.5/6 and 6.5/8 Ch were used. URSL was performed in 157 cases. During the first session, excellent results were obtained in 134 of 157 cases (85.3 %). In 15 cases (9.6 %), a second URSL was required. In five cases (3.2 %), URSL was performed a third time. A final stone-free rate of 98.1 % was obtained within the ureter. In three cases (1.9 %), complications were observed. In ten cases (6.37 %), a pigtail catheter was placed and retained in the ureter. URSL is a very good and effective endoscopic treatment for the removal of concrements localized in ureters. These concrements cause alterations in flow from the upper urinary tract in children. Because of the relatively small diameter and volume of the urinary tract in children aged <5 years, URSL in this population requires great precision, experience, and technical skill.
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Affiliation(s)
- Beata Jurkiewicz
- Department of Pediatric Surgery, Children's Hospital in Dziekanow Lesny, Warsaw, Poland
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Galal EM, Fath El-Bab TK, Abdelhamid AM. Outcome of ureteroscopy for treatment of pediatric ureteral stones. J Pediatr Urol 2013; 9:476-8. [PMID: 22841401 DOI: 10.1016/j.jpurol.2012.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE We assess the efficacy and safety of semirigid ureteroscopy for treatment of ureteral stones in children. MATERIALS AND METHODS The records of 18 non-consecutive children with symptomatic ureteral stones treated with ureteroscopy in 2008-2010 were reviewed. Mean age was 7.6 years (range 15 months-14 years). A semirigid (8F) ureteroscope was used in all cases. A 0.038-inch floppy-tipped guidewire was passed through the selected ureteric orifice, advanced under direct vision, and monitored fluoroscopically. Dilatation of the ureteral orifice was necessary in 7 cases. Either direct extraction or disintegration using a pneumatic lithotripter was performed. The follow-up period was 6 months. RESULTS Ureteroscopic procedures were successfully completed in 16 children (89%). Stones were located at the middle ureter in 3 (19%) cases and various levels of the lower third ureter in 13 (81%) cases. Stone size was 4-10 mm (mean 7 mm). Stones were fragmented with pneumatic lithotripsy in 9 (56%) cases and removed by forceps without fragmentation in 7 (44%). Stent was left in place for 3 days to 3 weeks in 12 (75%) cases. Early postoperative complications were insignificant hematuria in 2 patients and renal colic and fever in 3 patients. No complications were observed during the period of follow up. CONCLUSION Ureteroscopy is a feasible treatment option for ureteral stones in children, when in skilled hands and with the aid of experience gained in the adult population.
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Affiliation(s)
- Ehab Mohamad Galal
- Department of Urology, Minia University Hospital, P.O. 61111, Minia, Egypt.
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Altıntaş R, Beytur A, Oğuz F, Çimen S, Akdemir E, Güneş A. Minimally invasive approaches and their efficacy in pediatric urolithiasis. Turk J Urol 2013; 39:111-5. [PMID: 26328091 DOI: 10.5152/tud.2013.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 12/15/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We compared the frequency of usage and success of minimally invasive approaches in the management of pediatric urolithiasis in our clinic. MATERIAL AND METHODS Data from pediatric patients (≤16 years of age) who had undergone percutaneous nephrolithotomy (PNL), ureterorenoscopy (URS), and extracorporeal shock wave lithotripsy (ESWL) between January 2001 and December 2011 were retrospectively investigated. RESULTS In this study, 415 pediatric patients, who were treated for 291 renal, and 124 ureteral stones, were evaluated. The patients were treated with PNL (n=148; 82 boys, 66 girls), URS (n=99; 58 boys, and 41 girls) or ESWL (n=168; 91 boys, and 77 girls). The mean patient ages were 7.3 (1-16), 9.1 (1-16), and 8.8 (1-16) years in the PNL, URS, and ESWL groups, respectively. The stone-free rates after treatment with PNL, URS, and ESWL were 77, 83.8 and 88.7%, respectively. CONCLUSION It is important that selected therapies are properly planned, and the use of minimally invasive approaches is important in pediatric patients due to potentially high recurrence rates. Currently, ESWL, PNL and URS are performed with high success rates for the treatment of stones, and open surgery is rarely used due to the success obtained with minimally invasive approaches.
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Affiliation(s)
- Ramazan Altıntaş
- Department of Urology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Ali Beytur
- Department of Urology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Fatih Oğuz
- Department of Urology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Serhan Çimen
- Department of Urology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Ender Akdemir
- Department of Urology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Ali Güneş
- Department of Urology, Faculty of Medicine, İnönü University, Malatya, Turkey
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Uygun I, Okur MH, Aydogdu B, Arayici Y, Isler B, Otcu S. Efficacy and safety of endoscopic laser lithotripsy for urinary stone treatment in children. ACTA ACUST UNITED AC 2012; 40:751-5. [DOI: 10.1007/s00240-012-0495-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 07/06/2012] [Indexed: 10/28/2022]
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Patient Evaluation and Comparison of Stone-Removing Strategies in Pediatric Patients with Urinary Tract Stones. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Christman MS, Ziemba J, Casale P. Flexible ureteroscopy in children with von Willebrand disease. J Endourol 2011; 26:783-6. [PMID: 22204753 DOI: 10.1089/end.2011.0520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Treatment options for urolithiasis include shockwave lithotripsy (SWL), percutaneous nephrostolithotomy (PCNL), and ureteroscopy. While these treatment options are becoming the standard of care in the pediatric population, children with a bleeding dyscrasia must be approached differently. We report our flexible ureteroscopic experience in children with von Willebrand disease (vWd). PATIENTS AND METHODS A review of a prospectively maintained database of stone patients was performed. Children with a bleeding diathesis were identified. Stone burden, operative access, intraoperative complications, postoperative complications, stone-free status, and perioperative medical management were evaluated. RESULTS During a 7-year period, a total of five children with a bleeding disorder underwent 7 ureteroscopic and 10 cystoscopic procedures for urinary calculi. The mean patient age was 72.4 months (range 49-123 mos) at the time of the procedure. There were three boys and two girls. Mean follow-up was 29.7 months (range 8-79 mos). Mean stone burden was 6.1 mm (range 3-14 mm) with an average of 1.3 stones per patient. Four patients were known to have vWd before surgical intervention and were pretreated with desmopressin acetate. The remaining patient was found to have vWd based on significant bleeding after ureteral stent placement. No ureters were actively dilated. Flexible ureteroscopy was performed in all cases regardless of stone location. Stone clearance was 100% (7/7). Complications occurred in 6% of procedures (1/17). CONCLUSIONS Ureteroscopy is a safe and efficacious modality in the management of urolithiasis in children with a bleeding abnormality. Perioperative medical management of the bleeding diathesis may help reduce complications.
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Affiliation(s)
- Matthew S Christman
- Department of Urology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania 19035, USA.
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Retrograde intrarenal surgery in infants and preschool-age children. J Pediatr Surg 2011; 46:2195-9. [PMID: 22075358 DOI: 10.1016/j.jpedsurg.2011.07.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 06/07/2011] [Accepted: 07/04/2011] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objectives of this study are to present our experience with retrograde intrarenal surgery for management of renal calculi in children less than 7 years old and to determine its safety and efficacy in this age group. METHODS Patient demographics, stone location and size, use of ureteral access sheath, stone-free status, complication rates, and follow-up were evaluated. RESULTS A total of 16 patients (9 boys and 7 girls; mean age, 4.2 years) underwent 17 procedures. The mean stone size was 11.5 mm (8-17 mm). Flexible ureteroscopy and laser lithotripsy were performed in all cases regardless of stone location. Dilation of the ureteral orifice was required in 5 cases (29.4%), and ureteral access sheaths were placed in 3 patients (17.6%). With a mean follow-up of 10.3 months, 88% of the children were stone free. The success rate for stones less than 10 mm was 100% and 81.8% for stones 10 mm or more (P < .05). There were no major complications, but there was 1 case of perforation and extravasation at the ureterovesical junction after balloon dilation that was managed with stent placement. CONCLUSIONS Retrograde intrarenal surgery is a safe and effective method for the treatment of intrarenal calculi, and it achieves reasonable results with minimal complications in children less than 7 years old.
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Reddy PP, Defoor WR. Ureteroscopy: The standard of care in the management of upper tract urolithiasis in children. Indian J Urol 2011; 26:555-63. [PMID: 21369390 PMCID: PMC3034066 DOI: 10.4103/0970-1591.74459] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives Advances in technology and the continued evolution in the design of ureteroscopes now permit a primary endoscopic approach to the upper urinary tract of pediatric patients on a routine basis to treat a diverse group of conditions that include urolithiasis, hematuria and strictures. The purpose of this review article is to demonstrate that ureteroscopic lithotripsy is now to be considered the standard of care in the management of upper tract urolithiasis in the pediatric patient, replacing shockwave lithotripsy (ESWL) as the first line of therapy. Additionally, the article will discuss the available endoscopic equipment and the lessons learned over the years to optimize the success of these procedures in children. Materials and Methods A systematic review of articles written about ureteroscopy (URS) in the contemporary urological literature (1990-2009) on PubMed was undertaken. The success rates and complications of pediatric ureteroscopic procedures were abstracted from the identified publications and the results were tabulated and compared with the success rates of shockwave lithotripsy. Results In over 832 URS cases, there was a 5.9% complication rate and a stone-free rate of 93.4%. The stone-free rates of URS are superior to those obtained with the published success rates with ESWL of 80.3% in 1,839 cases. Conclusions The safety and outcomes of ureteroscopic lithotripsy in the management of pediatric urolithiasis now justify that this treatment modality be considered the standard of care and first line of therapy in the management of children who present with upper tract stones.
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Affiliation(s)
- Pramod P Reddy
- Surgical Services, Division of Pediatric Urology. Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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El-Hout Y, Elnaeema A, Farhat WA. Current status of retrograde intrarenal surgery for management of nephrolithiasis in children. Indian J Urol 2011; 26:568-72. [PMID: 21369392 PMCID: PMC3034068 DOI: 10.4103/0970-1591.74463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose To review the current status of retrograde intrarenal surgery (RIRS) for renal stones in children focusing on its indications, outcomes and success in the management of nephrolithiasis. Materials and Methods Between 1988 and 2009, a comprehensive PubMed/MEDLINE literature review on RIRS was conducted. Results The available literature is limited and heterogeneous, skewed by favorable results on ureteral stone outcomes. However, recent case series report outcomes comparable to time-honored modalities: percutaneous nephrolithotomy and shock wave lithotripsy. Concerns about urinary tract damage are not substantiated by the yet available intermediate-term follow-up. Conclusions RIRS seems to be an effective modality in pediatric nephrolithiasis management. However, long-term outcomes and comparative prospective randomized studies are awaited.
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Affiliation(s)
- Yaser El-Hout
- Division of Urology, The Hospital for Sick Children, Toronto, Canada
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Abstract
PURPOSE OF REVIEW The management of urolithiasis in children has significantly changed over the past 20 years. Extracorporeal shockwave lithotripsy (SWL) was initially the preferred modality of treatment. More recently, ureteroscopy and percutaneous nephrolithotomy (PCNL) are being used at an increasing frequency in the management of pediatric stone disease. RECENT FINDINGS Development has been made in various aspects of pediatric endoscopic stone management. Ureteroscopy and PCNL have been applied at an increasing frequency to treat pediatric stone disease, which has guided modifications to improve the procedures. Increased endoscopic experience with managing urolithiasis has broadened the indications wherein these methods are utilized. Technology is continually advancing to meet the needs of this population. Ureteroscopes have been modified to accommodate the pediatric ureter, optics advanced, and access sheaths are used to improve results. In addition, technique is constantly being refined. SUMMARY Further experience will direct surgeons as to when ureteroscopy and PCNL are appropriate. The incidence of urolithiasis is on the rise in developing nations; there is a need to address the most efficient method of treatment that minimizes the morbidity to the child.
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Ost MC, Docimo SG. Ureteroscopy. J Urol 2011; 185:1189-90. [PMID: 21419247 DOI: 10.1016/j.juro.2011.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael C Ost
- Department of Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Stentless pediatric ureteroscopic holmium: YAG laser stone disintegration: is gravels retrieval an issue? Int Urol Nephrol 2011; 43:613-7. [PMID: 21409524 DOI: 10.1007/s11255-011-9908-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of stentless pediatric ureteroscopic holmium laser stone disintegration without gravels retrieval. PATIENTS AND METHODS From Feb 2007 to Feb 2010, 21 children (12 boys and 9 girls) with unilateral single stone ureter, with an average age of 8.5 years (range 4-12 years), were treated with 6.9 Fr semirigid ureteroscope for a stone size ranged from 5 to 10 mm (mean 6.5 mm). All the stones were radioopaque, located in the upper ureter in 2 cases (9.5%), in the middle ureter in 5 cases (24%), and in the lower ureter in 14 cases (66.5%). Complete holmium laser stone disintegration was applied in all cases without gravels removal. No postoperative ureteral stent was inserted in any case. RESULTS The stones were successfully approached and completely disintegrated in a single session in 20 cases (95.2%). All the procedures were done without ureteral orifice dilatation apart from 3 cases where another working guide wire was applied. No intraoperative complications were recorded in the form of mucosal injury, ureteral perforation, or urinary extravasation. There is no early postoperative complication in the form of urinary tract infection or colic apart from single case of hematuria which was successfully treated conservatively. Two weeks postoperatively, KUB (kidney, ureter, and bladder) films were completely free from any significant gravel (>3 mm) and US showed no hydronephrosis. CONCLUSION Stentless ureteroscopic holmium laser disintegration without gravels removal is a safe and effective method for pediatric ureteral stone less than 10 mm in diameter.
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Experience on semirigid ureteroscopy and pneumatic lithotripsy in children at a single center. World J Urol 2010; 29:719-23. [DOI: 10.1007/s00345-010-0599-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 09/20/2010] [Indexed: 10/19/2022] Open
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Basiri A, Zare S, Tabibi A, Sharifiaghdas F, Aminsharifi A, Mousavi-Bahar SH, Ahmadnia H. A Multicenter, Randomized, Controlled Trial of Transureteral and Shock Wave Lithotripsy—Which is the Best Minimally Invasive Modality to Treat Distal Ureteral Calculi in Children? J Urol 2010; 184:1106-9. [DOI: 10.1016/j.juro.2010.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Abbas Basiri
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M. C. (SBMU), Tehran, I. R. Iran
| | - Samad Zare
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M. C. (SBMU), Tehran, I. R. Iran
| | - Ali Tabibi
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M. C. (SBMU), Tehran, I. R. Iran
| | - Farzaneh Sharifiaghdas
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M. C. (SBMU), Tehran, I. R. Iran
| | - Alireza Aminsharifi
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M. C. (SBMU), Tehran, I. R. Iran
| | - Seyed Habibollah Mousavi-Bahar
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M. C. (SBMU), Tehran, I. R. Iran
| | - Hassan Ahmadnia
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M. C. (SBMU), Tehran, I. R. Iran
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Turunc T, Kuzgunbay B, Gul U, Kayis AA, Bilgilisoy UT, Aygun C, Ozkardes H. Factors Affecting the Success of Ureteroscopy in Management of Ureteral Stone Diseases in Children. J Endourol 2010; 24:1273-7. [DOI: 10.1089/end.2009.0476] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tahsin Turunc
- Faculty of Medicine, Department of Urology, Baskent University, Ankara, Turkey
| | - Baris Kuzgunbay
- Faculty of Medicine, Department of Urology, Baskent University, Ankara, Turkey
| | - Umit Gul
- Faculty of Medicine, Department of Urology, Baskent University, Ankara, Turkey
| | - Aliye Atay Kayis
- Faculty of Economic and Administrative Sciences, Department of Econometrics, Suleymen Demirel University, Isparta, Turkey
| | | | - Cem Aygun
- Faculty of Medicine, Department of Urology, Baskent University, Ankara, Turkey
| | - Hakan Ozkardes
- Faculty of Medicine, Department of Urology, Baskent University, Ankara, Turkey
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Thomas JC. How effective is ureteroscopy in the treatment of pediatric stone disease? UROLOGICAL RESEARCH 2010; 38:333-335. [PMID: 20617310 DOI: 10.1007/s00240-010-0293-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 06/24/2010] [Indexed: 05/29/2023]
Abstract
Pediatric ureteroscopy has been increasingly used to manage both ureteral and renal stones. Unfortunately, there are no current standardized recommendations when treating pediatric stone disease so the modality chosen is left to the treating surgeon. A review of the current literature on pediatric ureteroscopy was used to compile this article. For the purposes of this review, the majority of series include stones < or =1 cm. Ureteroscopy is considered to be first-line therapy in treating mid- to distal ureteral stones and is rapidly evolving as an acceptable first-line therapy for renal stones as well. Limitations do exist and include stone composition, location, size, as well as the unique anatomic challenges faced by pediatric urologists in terms of anomalous kidneys and/or reconstructed urinary tracts. In conclusion, ureteroscopy can be considered first-line therapy for mid- or distal ureteral stones, however, it shares a similar efficacy rate as extracorporeal shock wave lithotripsy for the treatment of renal calculi. There is a need for direct comparison in the literature of all modalities treating pediatric stone disease to facilitate guidelines that help treating surgeons choose the most efficacious modality offering the highest success rates with the lowest morbidity.
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Affiliation(s)
- John C Thomas
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, 4102 Doctor's Office Tower, Nashville, TN 37232-9820, USA.
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Smaldone MC, Docimo SG, Ost MC. Contemporary surgical management of pediatric urolithiasis. Urol Clin North Am 2010; 37:253-67. [PMID: 20569803 DOI: 10.1016/j.ucl.2010.03.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
With miniaturization of instruments and refinement of surgical technique, the management of pediatric stone disease has undergone a dramatic evolution. While shock wave lithotripsy (SWL) is still commonly used to treat upper tract calculi, the use of ureteroscopy (URS) has dramatically increased and is now the procedure of choice for upper tract stone burdens less than 1.5cm at centers with significant experience. Percutaneous nephrolithotomy (PCNL) has replaced open surgical techniques for the treatment of large stone burdens greater than 2cm, with efficacy and complication rates similar to the adult population. Large institutional series demonstrate comparable stone-free and complication rates with SWL, URS, and PCNL, but concerns remain with these techniques regarding renal development and damage to the pediatric urinary tract. Randomized controlled trials comparing the efficacy of SWL and URS for upper tract stone burdens are needed to reach consensus regarding the most effective primary treatment modality in children.
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Affiliation(s)
- Marc C Smaldone
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213-3232, USA.
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Abstract
Children represent about 1% of all patients with urolithiasis, but 100% of these children are considered high risk for recurrent stone formation, and it is crucial for them to receive a therapy that will render them stone free. In addition, a metabolic workup is necessary to ensure a tailored metaphylaxis to prevent or delay recurrence. The appropriate therapy depends on localization, size, and composition of the calculus, as well as on the anatomy of the urinary tract. In specialized centers, the whole range of extracorporeal shock-wave lithotripsy (ESWL), ureterorenoscopy (URS), and percutaneous nephrolithotomy (PCNL) are available for children, with the same efficiency and safety as in adults.
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Abstract
Urinary stone disease is less common in children than adults. Although many aspects of pediatric stone disease are similar to that of adults, there are unique concerns regarding the presentation, diagnosis, and management of stone disease in children. We present a review of the increasing prevalence of pediatric stone disease, the diagnostic concerns specific to children, recent results from pediatric series regarding the expectant management and surgical treatment of stones, metabolic evaluation, and current research on the genetics of nephrolithiasis.
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Smaldone MC, Corcoran AT, Docimo SG, Ost MC. Endourological management of pediatric stone disease: present status. J Urol 2008; 181:17-28. [PMID: 19012920 DOI: 10.1016/j.juro.2008.09.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Indexed: 01/26/2023]
Abstract
PURPOSE The incidence of nephrolithiasis in the pediatric population has been steadily increasing. The miniaturization of endoscopic instruments and improvement in imaging modalities have facilitated safe and effective endourological treatment in this patient population. We reviewed the current status of pediatric stone disease management. MATERIALS AND METHODS A comprehensive literature review was performed using MEDLINE/PubMed to evaluate the indications, techniques, complications and efficacy of endourological stone management in children. RESULTS In the 1980s shock wave lithotripsy revolutionized stone management in children, becoming the procedure of choice for treating upper tract calculi less than 1.5 cm. Percutaneous nephrolithotomy has replaced open surgical techniques for the treatment of stone burdens greater than 1.5 cm with efficacy and complication rates mirroring those in the adult population. However, at an increasing number of centers ureteroscopy is now being performed in cases that previously would have been treated with shock wave lithotripsy or percutaneous nephrolithotomy. Results from recent retrospective series demonstrate that stone-free rates and complication rates with ureteroscopy are comparable to percutaneous nephrolithotomy and shock wave lithotripsy. Although concerns remain with all endoscopic techniques in children regarding damage to the urinary tract and renal development, neither short-term nor long-term adverse effects have been consistently reported. CONCLUSIONS Shock wave lithotripsy, percutaneous nephrolithotomy and ureteroscopy are highly effective endourological techniques to treat stone disease in the pediatric population. A lack of prospective randomized trials comparing treatment modalities coupled with a vast disparity in the access to resources worldwide continues to individualize rather than standardize stone treatment in children.
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Affiliation(s)
- Marc C Smaldone
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Kim SS, Kolon TF, Canter D, White M, Casale P. Pediatric flexible ureteroscopic lithotripsy: the children's hospital of Philadelphia experience. J Urol 2008; 180:2616-9; discussion 2619. [PMID: 18950810 DOI: 10.1016/j.juro.2008.08.051] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Indexed: 11/16/2022]
Abstract
PURPOSE Therapeutic options currently available for urinary stones include shock wave lithotripsy, percutaneous nephrolithotomy and ureteroscopic treatment. While these treatment options have become the standard of care in the adult population, the same has not necessarily been applied to the pediatric population, despite an increasing prevalence of stone disease in children. We report our flexible ureteroscopic experience with urinary stones in children. MATERIALS AND METHODS A total of 170 ureteroscopic treatments were performed. Demographic information was collected. Stone burden was measured in millimeters. Operative access, operative times, intraoperative complications, stone-free status and postoperative complications were evaluated. RESULTS A total of 167 children (89 boys and 78 girls) underwent 170 ureteroscopic procedures for urinary calculi. Mean patient age was 62.4 months at the time of the procedure (range 3 to 218). Mean followup was 19.7 months (range 6 to 39). Mean stone burden was 6.12 mm (range 3 to 24), with an average of 1.3 stones per patient. Retrograde access could not be obtained in 95 of the children (57%). No ureters were actively dilated. Flexible ureteroscopy was performed in all cases regardless of stone location. Stone clearance was 100% for stone burdens 10 mm or less and 97% for burdens greater than 10 mm after 1 ureteroscopy. CONCLUSIONS Pediatric ureteroscopy is a safe and efficacious modality in the treatment of all upper urinary tract calculi, including lower pole calculi.
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Affiliation(s)
- Steve S Kim
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania 19035, USA
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Corcoran AT, Smaldone MC, Mally D, Ost MC, Bellinger MF, Schneck FX, Docimo SG, Wu HY. When is Prior Ureteral Stent Placement Necessary to Access the Upper Urinary Tract in Prepubertal Children? J Urol 2008; 180:1861-3; discussion 1863-4. [DOI: 10.1016/j.juro.2008.03.106] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Indexed: 11/30/2022]
Affiliation(s)
- Anthony T. Corcoran
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marc C. Smaldone
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dev Mally
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael C. Ost
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mark F. Bellinger
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Francis X. Schneck
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven G. Docimo
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hsi-Yang Wu
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Tanaka ST, Makari JH, Pope JC, Adams MC, Brock JW, Thomas JC. Pediatric ureteroscopic management of intrarenal calculi. J Urol 2008; 180:2150-3; discussion 2153-4. [PMID: 18804225 DOI: 10.1016/j.juro.2008.07.079] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Indexed: 11/17/2022]
Abstract
PURPOSE Data addressing ureteroscopic management of intrarenal calculi in prepubertal children are limited. We reviewed our experience from January 2002 through December 2007. MATERIALS AND METHODS We retrospectively reviewed ureteroscopic procedures for intrarenal calculi in children younger than 14 years. Stone-free status was determined with postoperative imaging. Multiple logistic regression analysis was used to assess the influence of preoperative factors on initial stone-free status and the need for additional procedures. RESULTS Intrarenal calculi were managed ureteroscopically in 52 kidneys in 50 children with a mean age of 7.9 years (range 1.2 to 13.6). Mean stone size was 8 mm (range 1 to 16). Stone-free rate after a single ureteroscopic procedure was 50% (25 of 50 patients) on initial postoperative imaging and 58% (29 of 50) with extended followup. Initial stone-free status was dependent on preoperative stone size (p = 0.005) but not stone location. Additional stone procedures were required in 18 upper tracts. Younger patient age (p = 0.04) and larger preoperative stone size (p = 0.002) were associated with the need for additional procedures. Additional procedures were required in more than half of the stones 6 mm or larger but in no stone smaller than 6 mm. CONCLUSIONS Ureteroscopy is a safe method for the treatment of intrarenal calculi in the prepubertal population. Our ureteroscopic stone-free rate for intrarenal stones is lower than that reported for ureteral stones. Parents should be informed that additional procedures will likely be required, especially in younger patients and those with stones larger than 6 mm.
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Affiliation(s)
- Stacy T Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee 37232-9820, USA.
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Smaldone MC, Cannon GM, Wu HY, Bassett J, Polsky EG, Bellinger MF, Docimo SG, Schneck FX. Is ureteroscopy first line treatment for pediatric stone disease? J Urol 2007; 178:2128-31; discussion 2131. [PMID: 17870124 DOI: 10.1016/j.juro.2007.07.050] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Indexed: 11/24/2022]
Abstract
PURPOSE We report our current outcomes for ureteroscopic management of pediatric stone disease. MATERIALS AND METHODS We carried out a retrospective review of all ureteroscopic procedures for kidney or ureteral calculi performed between 2001 and 2005. Stone location and size, preoperative and postoperative stenting, intraoperative dilation, use of ureteral access sheath, stone-free rates and complications were noted. RESULTS A total of 100 patients (58% female, mean age 13.2 years) underwent 115 procedures. Stones were located in the renal pelvis in 6% of patients, upper pole in 10%, mid ureter in 11%, lower pole in 17%, proximal ureter in 19% and distal ureter in 37%. Mean stone size was 8.3 mm (median 7.0), with a mean of 1.5 stones per patient. Preoperative stenting was used in 54% of patients, and a stent was placed postoperatively in 76%. Ureteral coaxial dilators and ureteral access sheaths were used in 70% and 24% of patients, respectively. There were no major intraoperative complications, although 5 patients required stent placement for ureteral perforation or extravasation. One patient had a ureteral stricture requiring ureteral reimplantation. Mean followup was 10.1 months (median 2.6). Stone-free rate was 91% on followup ultrasound, abdominal radiography or computerized tomography. Seven patients required staged ureteroscopic procedures to achieve stone-free status. While the number of percutaneous nephrolithotomy and shock wave lithotripsy cases remained stable, the number of ureteroscopic cases increased 7-fold during this period. CONCLUSIONS Improved ureteroscopic access to stones throughout the pediatric urinary tract and stone-free rates that are comparable to the adult population have led to the adoption of ureteroscopy as first line therapy in children at our institution.
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Affiliation(s)
- Marc C Smaldone
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213-3232, USA.
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