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Abuelnaga M, Esmat M, Hatata AN, Samir YR, Arafa H, Salem MS. Clinical efficacy of mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the management of upper urinary tract calculus (1-2.5 cm) in children ≤10 years of age. J Pediatr Urol 2024; 20:605.e1-605.e8. [PMID: 38851968 DOI: 10.1016/j.jpurol.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/08/2024] [Accepted: 05/22/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND With improvements in endoscopic surgery, open surgical procedures for urinary system stones have cleared the path for the use of less invasive treatment modalities in patients with pediatric kidney stone disease. Extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS) are among the treatment options available. OBJECTIVE To prospectively evaluate the outcomes of mini-percutaneous nephrolithotomy and retrograde intrarenal surgery (RIRS) for children ≤10 years of age with upper urinary tract calculus (1-2.5 cm). STUDY DESIGN Sixty pediatric patients with single or multiple renal stones (1-2.5 cm in diameter) were collected prospectively and equally divided into two groups to undergo RIRS or mini-PCNL. The operative and postoperative outcomes of both groups were analyzed. RESULTS The groups' mean ages and genders were comparable. The mean stone size for the RIRS group was 1.86 cm and 1.69 cm for the PCNL group (P = 0.449). The PCNL group had statistically longer mean fluoroscopy and hospitalization times. The stone-free rates (SFRs) after a single procedure were 27 (90%) in the PCNL group and 25 (83.33%) in the RIRS group (P = 0.706). The UAS was placed in 13 (43.33%) patients in the RIRS group. In the RIRS group, 14 (46.67%) children required preoperative DJ stent application to passively dilate the ureteric orifice. As regard post DJ stenting, 13 (46%) cases applied DJ in the mini PCNL group. major complications were observed in either group. Minor complication (Clavien 1-3) rates were 16.66% and 13.33% for the PCNL and RIRS groups, respectively. There were no differences found between the RIRS and mini-PCNL groups regarding operative time. The mean cost of RIRS was $703.96 and $537.03 for the mini-PCNL. CONCLUSION According to the results of this study, mini-PCNL and RIRS are effective procedures for treating renal stones in children up to 2.5 cm with comparable success and complication rates. Hospital stay, radiation exposure, and fluoroscopy time are significantly lower in RIRS than in the mini PCNL technique. Although RIRS is effective, a major disadvantage is the greater requirement for JJ stent insertion either before or after the procedure and the consequent need for a second procedure for removal.
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Peng G, Kuang J, Chen Y, Huang X, Song L, Deng X. Flexible Ureteroscopy with a Tip-Flexible Pressure-Controlling Ureteral Access Sheath for Renal Stones in Children. Urol Int 2024; 108:429-433. [PMID: 38754402 DOI: 10.1159/000539311] [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: 02/29/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION The aim of this study was to evaluate the safety and efficacy of flexible ureteroscopy using a tip-flexible pressure-controlling ureteral access sheath (TFPC-UAS) for renal stones in children. METHODS Consecutive patients aged 5-18 years with renal stones of diameter 1-3 cm were enrolled between January 2022 and November 2023 at Ganzhou People's Hospital. The patients were treated with flexible ureteroscopy using the TFPC-UAS. The renal pelvic pressure (RPP) parameters were set as follows: control value at -10 mm Hg to 5 mm Hg, warning value at 20 mm Hg, and limit value at 30 mm Hg. The infusion flow rate was set to 100-120 mL/min. A holmium laser (276 μm) was used to fragment the stone at 2.0-2.5 J/pulse with a frequency of 20-30 pulses/s. The cases were analyzed for RPP, operative time, stone-free rate, and complications. RESULTS A total of 21 consecutive patients were included. Two patients were switched to percutaneous nephrolithotomy owing to sheath placement failure. The RPP was -4.6 ± 2.1 mm Hg. The mean operative time was 56.5 ± 17.1 min. The postoperative hospitalization time was 1.5 ± 0.3 days. The stone-free rates at 1 day and 1 month after surgery were 81.0% and 85.7%, respectively. Residual stones in 2 patients were cleared after extracorporeal shockwave lithotripsy. Three cases of Clavien I complications and one case of Clavien II complications occurred. No major complications (Clavien grade III-V) were observed. CONCLUSIONS Flexible ureteroscopy with a TFPC-UAS is safe and effective for renal stones in children.
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Affiliation(s)
- Guanghua Peng
- Department of Urology, Ganzhou People's Hospital, Ganzhou, China
| | - Jin Kuang
- Department of Urology, Ganzhou People's Hospital, Ganzhou, China
| | - Yijian Chen
- Department of Anesthesia, Ganzhou People's Hospital, Ganzhou, China
| | - Xin Huang
- Department of Urology, Ganzhou People's Hospital, Ganzhou, China
| | - Leming Song
- Department of Urology, Ganzhou People's Hospital, Ganzhou, China
| | - Xiaolin Deng
- Department of Urology, Ganzhou People's Hospital, Ganzhou, China
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Campbell P, Mudd B, Craig K, Daugherty M, Vanderbrink B, DeFoor W, Minevich E, Reddy P, Strine A. One and done: Feasibility and Safety of Primary Ureteroscopy in a Pediatric Population. J Pediatr Urol 2024; 20:224.e1-224.e7. [PMID: 37957074 DOI: 10.1016/j.jpurol.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Pediatric urolithiasis has been increasing at rate of 4-10 % annually in the United States, most notably within adolescents and females. A significant number of patients will require surgical management of their stones. Primary ureteroscopy (URS) affords the opportunity to treat stones under a single anesthetic with lower re-treatment rates or anatomical and stone characteristic limitations compared to shockwave lithotripsy. Previous studies evaluating primary URS have been largely underpowered, are limited by stone location, and/or are not representative of the stone population in the United States. OBJECTIVES Primary study outcomes were the success of primary URS and patient characteristics associated with success. Secondary outcomes were the stone-free rate (SFR), 30-day emergency department (ED) visits, 30-day readmissions, and complications. METHODS We performed a retrospective cohort study of patients less than 18 years of age from 2011 to 2023 who underwent primary URS. Patients were excluded if a ureteral stent was placed prior to URS or diagnostic URS was performed. A successful primary URS was considered if access to the ureter was obtained and treatment of the stone(s) completed. In failed primary URS, a ureteral stent was placed for staged management. RESULTS A total of 196 patients were included and primary URS was performed or attempted on 224 renal units. The median age was 15.8 (IQR 13.4-16.9) years and median follow up 8.4 (IQR 1.1-24.6) months. The success rate of primary URS was 79 %. No significant characteristics were appreciated for successful primary URS based on: overall age, <14 vs > 14 years of age, sex, body mass index, history of stones, history of endourologic procedures, preoperative alpha blockade, location of stone(s), multiple stones, type of URS, or acute treatment. In successful primary URS, the SFR was 88 % with stone size (p = 0.0001) the only predictor of having residual stones. The 30-day ED rate was 21.4 %, 30-day unplanned readmission rate was 12.5 %, and complication rate was 7.5 %. No long-term complications were appreciated. DISCUSSION Our success of primary URS compares favorably to previously published literature. Our SFR rate, 30-day ED visits, 30-day unplanned readmission, and complication rates are similar to other studies. Limitations of the study are its retrospective design, selection bias, and intermediate follow-up. CONCLUSIONS Primary URS can be completed safely in the majority of pediatric patients without any patient characteristics associated with success. We advocate for primary URS when possible due to the excellent SFR and potential of treating stones under a single anesthetic.
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Affiliation(s)
- Paul Campbell
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Brandon Mudd
- University of Cincinnati, Department of Urology, Cincinnati, OH, 231 Albert Sabin Way, Cincinnati, OH 45267, USA.
| | - Kiersten Craig
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Michael Daugherty
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Brian Vanderbrink
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - William DeFoor
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Eugene Minevich
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Pramod Reddy
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Andrew Strine
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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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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Sinha M, Pietropaolo A, Quiroz Madarriaga Y, de Knecht EL, Bujons Tur A, Griffin S, Somani BK. Outcomes of ureteroscopy for management of stone disease in early and late childhood over a 15-year period. Ther Adv Urol 2022; 14:17562872221141775. [PMID: 36568063 PMCID: PMC9772971 DOI: 10.1177/17562872221141775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 11/10/2022] [Indexed: 12/24/2022] Open
Abstract
Background Although paediatric ureteroscopy is widely performed, there is still a lack of data and outcomes in early childhood. In this two-centre study, we compared the outcomes of ureteroscopy for stone disease management in early and late childhood and provide outcomes for the same. Methods Data was retrospectively collected on consecutive patients from two tertiary paediatric endo-urology European centres over a 15-year period (2006-2021). Patients were split into two groups, namely, early childhood (age ⩽ 9 years) and late childhood (age 9 to ⩽16 years). Outcomes including stone-free rate (SFR) and complications were compared between these two groups. Results A total of 148 patients underwent 184 procedures (1.2 procedure/patient) during the study period (66 in early childhood and 82 in late childhood). The mean age in early and late childhood groups were 5.6 and 13.3 years, and a male: female ratio of 1.6:1 and 1.1:1, respectively. The SFR and complications in early and late childhood groups were 87.8% and 90.2% (p = 0.64) and 5.7% and 4.1%, respectively. Conclusion Paediatric ureteroscopy and laser stone fragmentation achieves good results in both early and late childhood with comparable SFRs, although the complications and need for second procedure were marginally higher in the early childhood group. Our study would set up a new benchmark for patient counselling in future, and perhaps this needs to be reflected in the paediatric urolithiasis guidelines.
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Affiliation(s)
- Mriganka Sinha
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | | | - Anna Bujons Tur
- Pediatric Urology Unit, Urology Department, Fundació Puigvert, Barcelona, Spain
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Ripa F, Tokas T, Griffin S, Ferretti S, Bujons Tur A, Somani BK. Role of Pediatric Ureteral Access Sheath and Outcomes Related to Flexible Ureteroscopy and Laser Stone Fragmentation: A Systematic Review of Literature. EUR UROL SUPPL 2022; 45:90-98. [PMID: 36267473 PMCID: PMC9576810 DOI: 10.1016/j.euros.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 11/17/2022] Open
Abstract
Context Flexible ureteroscopy and laser lithotripsy (FURSL) represent a good treatment option for pediatric urolithiasis. Scarce evidence is available about the safety and efficacy of the concomitant use of a ureteral access sheath (UAS) in the setting of pediatric ureteroscopy (URS). Objective To acquire all the available evidence on UAS usage in pediatric FURSL, focusing on intra- and postoperative complications and stone-free rates (SFRs). Evidence acquisition We performed a systematic literature research using PubMed/MEDLINE, Embase, and Scopus databases. The inclusion criteria were cohorts of pediatric patients <18 yr old, submitted to URS for FURSL, reporting on more than ten cases of UAS placement. The primary outcomes were prestenting rates, operating time, ureteric stent placement rates after surgery, rates and grades of complications, ureteral injuries, and overall SFR. A total of 22 articles were selected. Evidence synthesis In total, 26 intraoperative and 130 postoperative complications following URS with UAS placement were reported (1.8% and 9.18% of the overall procedures, respectively). According to the Clavien-Dindo classification, 32 were classified as Clavien I, 29 as Clavien II, 43 as Clavien I or II, six as Clavien III, and one as Clavien IV. Twenty-one cases of ureteral injuries (1.59%) were noted in the whole cohort; most of them were ureteral perforation or extravasation, and were treated with a temporary indwelling ureteric stent. The overall SFR after a single URS procedure was 76.92%; after at least a second procedure, it was 84.9%. Conclusions FURSL is a safe and effective treatment option for pediatric urolithiasis. UAS use was associated with a low rate of ureteric injuries, mostly treated and resolved with a temporary indwelling ureteric stent. Patient summary We performed a systematic literature research on the utilization of a UAS during ureteroscopy for stone treatment in pediatric patients. We assessed the outcomes related to the rates of intra- and postoperative complications and the rates of efficacy of the procedure in the clearance of stones. The evidence shows a low rate and grade of complications associated with UAS placement and good stone-free outcomes. A ureteric injury may occur in 1.6% of cases, but it is usually managed and resolved with a temporary indwelling ureteric stent.
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Affiliation(s)
- Francesco Ripa
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall in Tirol, Hall in Tirol, Austria,Training and Research in Urological Surgery and Technology (T.R.U.S.T.) Group
| | - Stephen Griffin
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Bhaskar K. Somani
- University Hospital Southampton NHS Foundation Trust, Southampton, UK,Corresponding author. University Hospital Southampton NHS Trust, Southampton, UK. Tel. +44 02381206873.
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Mu XN, Guo LF, Wang PX, Zhang LY, Wang SJ. Semirigid Ureteroscopy Therapy against Childhood Kidney Stones. Appl Bionics Biomech 2022; 2022:7771920. [PMID: 35979239 PMCID: PMC9377984 DOI: 10.1155/2022/7771920] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/22/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The purpose of the current study was to assess the effectiveness of semirigid ureterorenoscopy (URS) as first-line therapy for early childhood patients with <20 mm stones in the pelvic, middle, or upper calices. Methods In all, 61 pediatric kidney stone patients who had flexible ureteroscopy (fURS) between January 1, 2010, and December 31, 2019, were included in this study. Before fURS, semirigid URS employed the UreTron or holmium: YAG (Ho : YAG) laser was conducted. When semirigid URS was unsuccessful, fURS was used for retrograde intrarenal surgery (RIRS). All participants were monitored clinically for a minimum of three months after each procedure. Results The patient's mean age was 4.52 ± 1.53 years, and 52 (83.61%) participants underwent semirigid URS successfully. Mean procedural duration of semirigid URS was 36.49 ± 7.72 min. The stone-free rate after semirigid URS was 92.16% (47/51). During the postprocedural medical observation, there were no serious adverse effects. Conclusions Based on the present study's findings, semirigid URS is a low-risk, effective therapy for kidney stones in selected pediatric patients.
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Affiliation(s)
- Xiao-Nan Mu
- Cadres Integrative Unit 2, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013 Shandong, China
| | - Long-Fei Guo
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013 Shandong, China
| | - Peng-Xin Wang
- College of Basic Medicine, Jining Medical University, Jining, 272067 Shandong, China
| | - Long-Yang Zhang
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013 Shandong, China
| | - Si-Jun Wang
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013 Shandong, China
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Karunakaran P, Pathak A, Shandilya G, Puneeth Kumar KM, Anand M, Yadav P, Srivastava A, Ansari MS. Safety and efficacy of retrograde intrarenal surgery in primary and residual renal calculi in children. J Pediatr Urol 2022; 18:312.e1-312.e5. [PMID: 35474161 DOI: 10.1016/j.jpurol.2022.03.017] [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: 11/11/2021] [Revised: 02/23/2022] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Minimal invasive approach is the current standard of care in the management of pediatric renal calculi. Current guidelines are clear with extra corporal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL) for stone size less than and greater than 20 mm respectively. Although retrograde intrarenal surgery (RIRS) is well established in adults but literature on its role, safety and efficacy in children is sparsely available. OBJECTIVE To share our experience of RIRS and its outcome in a pediatric population in both primary and residual calculi of size less than 20 mm. MATERIALS AND METHODS We retrospectively analysed data of children who underwent RIRS for either primary or residual renal calculi from January 2017 to January 2021. Children less than 5 years underwent passive ureteric dilatation with stenting preoperatively. A7.5 Fr flexible ureteroscope with an access sheath was used in all cases while performing RIRS. All the patients had a stent left in situ at the end of the procedure. Data including stone burden, number of sittings, operative time, stone-free rate (SFR) and grade of post procedural complications were analysed with appropriate statistical methods. RESULTS A total of 20 patients were included in this study. The median age at presentation was 9 years ranging from 9 months to 18 years. Eight patients (40%) presented with primary renal calculi and underwent RIRS directly while the rest of the 12 (60%) had residual calculi following other procedures like SWL, PCNL before undergoing RIRS. Seven patients (35%) had congenital renal anomalies. The mean stone size and operating time (OR) was 12.6 ± 3.2 mm 84.5 ± 7.2 min respectively. The post-procedural complications were seen in 4 (20%) patients in the form of Grade-1 modified Clavein classification in 3 and Grade 2 in 1 patient. The 100% stone-free rate was achieved in 80% of the cases after first attempt. DISCUSSION In the present series, RIRS was effective in both the types of stones (primary and residual) less than 20 mm in size, showing 100% stone free rate with maximum of two attempts. Choosing age based optimised passive ureteric dilation led to injury free access for RIRS. Overall complications remained with in low grades and are comparable to current literature. Limitations of the study include small cohort, retrospective study and the need of three anaesthesia procedures in children under 5 years of age. CONCLUSION RIRS is safe and effective in children with a renal stone(s) less than 20 mm and it has a high success rate in term of achieving stone free status in both primary and residual calculi.
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Affiliation(s)
- Prabhu Karunakaran
- Division of Paediatric Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, -226014 , India
| | - Abhishek Pathak
- Division of Paediatric Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, -226014 , India
| | - Gaurav Shandilya
- Division of Paediatric Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, -226014 , India
| | - K M Puneeth Kumar
- Division of Paediatric Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, -226014 , India
| | - Madhur Anand
- Division of Paediatric Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, -226014 , India
| | - Priyank Yadav
- Division of Paediatric Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, -226014 , India
| | - Aneesh Srivastava
- Division of Paediatric Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, -226014 , India
| | - M S Ansari
- Division of Paediatric Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, -226014 , India.
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Juliebø-Jones P, Æsøy MS, Gjengstø P, Beisland C, Ulvik Ø. Ureteroscopy for stone disease in the paediatric population: lessons learned and outcomes in a Nordic setting. Ther Adv Urol 2022; 14:17562872221118727. [PMID: 36032655 PMCID: PMC9403456 DOI: 10.1177/17562872221118727] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/14/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction: Paediatric stone disease is rare in the Nordic communities. Still, the
condition can require surgical intervention in the form of ureteroscopy
(URS). Here, we report outcomes achieved at a regional (tertiary)
centre. Patients and methods: Retrospective analysis was performed of consecutive patients (<18 years of
age) undergoing URS for stone disease between 2010 and 2021. Outcomes of
interest included stone-free rate (SFR) determined using a definition of no
residual fragments ⩾ 3 mm on imaging and complications classified according
to Clavien–Dindo system. Results: In total, 23 patients underwent 47 URS procedures for a total of 31 stone
episodes. Mean age was 9 (range 1–17) years and male-to-female ratio was
6:17. Overall, 35% had at least one medical comorbidity. Ultrasound
determined preoperative stone status in 87%. Mean largest index and
cumulative stone sizes were 9 (range 3–40) and 12 (range 3–40) mm,
respectively. Overall, 32% had multiple stones. Lower pole was the commonest
stone location (39%). No patients underwent elective pre-operative stenting.
Ureteral access sheaths were not used in any cases. Access to upper urinary
tract at first procedure was successful in 94%. Initial and final SFR was
61% and 90%, respectively. No intra-operative complications were recorded.
Overall post-operative complication rate was 17.5%. Urinary tract infection
(CD II) was the commonest adverse event (12.5%). Conclusion: Paediatric URS can be delivered in the setting of a regional centre without
compromising outcomes. This includes when carried out by adult
endourologists, without routine pre-stenting and omitting use of ureteric
access sheath.
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
| | | | - Peder Gjengstø
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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McGee LM, Sack BS, Wan J, Kraft KH. The effect of preoperative tamsulosin on ureteroscopic access in school-aged children. J Pediatr Urol 2021; 17:795.e1-795.e6. [PMID: 34544632 DOI: 10.1016/j.jpurol.2021.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 06/02/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Flexible ureteroscopes are not tailored for pediatric ureteral size and may not pass at first attempt into the pediatric ureter. Administration of tamsulosin preoperatively in adults has been shown to facilitate ureteral access sheath placement. Several studies have shown tamsulosin to be safe and effective when utilized for medical expulsive therapy in pediatric patients, but its utility for preoperative ureteral dilation has not been studied to date. OBJECTIVE We hypothesized that preoperative tamsulosin reduces failed ureteroscopic access in children. MATERIALS AND METHODS We conducted a retrospective review of patients aged 0-18 years undergoing flexible ureteroscopy (URS) from 2014 to 2019 at a single institution. Patients were divided into those taking 0.4 mg of tamsulosin daily for at least 1 week prior to surgery and those not taking tamsulosin. The primary outcome was failure to pass a 7.95 Fr flexible ureteroscope on initial attempt, requiring stent placement and staged management. Patients undergoing URS or stent placement within the prior year, requiring semi-rigid URS, or with genitourinary anomalies were excluded. RESULTS AND DISCUSSION A total of 49 patients met inclusion criteria. The tamsulosin group (n = 13) and non-tamsulosin group (n = 36) were similar with respect to demographic data. The percentage of prepubertal patients was 53% vs 33% (p = 0.19). The tamsulosin group had lower failed URS (38% vs 61%, p = 0.20). When stratified by age, both prepubertal and postpubertal patients in the tamsulosin group had lower failed URS (43% vs 67%, p = 0.67 and 33% vs 58%, p = 0.38). These clinically significant results suggest initial passage of a flexible ureteroscope is more successful in pediatric patients on preoperative tamsulosin. This study was largely limited by its low power and flaws inherent to its retrospective design. CONCLUSION Our results have implications for prescribing tamsulosin preoperatively to reduce multiple procedures and anesthetics in children. Adequately powered prospective trials are warranted to confirm preoperative tamsulosin reduces failed first-attempt flexible URS in children.
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Affiliation(s)
- Lauren M McGee
- Department of Urology, Oregon Health & Science University, Portland, OR, USA.
| | - Bryan S Sack
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
| | - Julian Wan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
| | - Kate H Kraft
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
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Kahraman O, Dogan HS, Asci A, Asi T, Haberal HB, Tekgul S. Factors associated with the stone-free status after retrograde intrarenal surgery in children. Int J Clin Pract 2021; 75:e14667. [PMID: 34320260 DOI: 10.1111/ijcp.14667] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Paediatric urolithiasis has a recurrent nature because it is frequently associated with metabolic or anatomical disorders or infectious conditions. The rising incidence of the disease with its recurrent nature emphasises the need for minimally invasive therapeutic options. In this study, we aimed to evaluate efficacy and factors affecting the success of retrograde intrarenal surgery (RIRS) in children. MATERIALS AND METHODS Patients who underwent RIRS were evaluated retrospectively. Two different flexible ureteroscopes (F-URS) were used (7.5F F-URS and 7.95F with a 4.9F bullet-shaped tip). Irrespective of size, all residual fragments were considered as failure. Age, stone size, stone localisation, Hounsfield Unit (HU), stone-free rate (SFR) and complications were evaluated. RESULTS Forty-six patients (29 boys and 17 girls) with a median age of 70.5 months (6-214 months) were treated with RIRS between August 2014 and November 2019. The median operative time was 60 minutes (45-120 minutes). The median follow-up was 26 months (3-65 months). Fourteen patients had lower pole and 10 patients had multiple stones. Ureteral access sheath (UAS) was used in 16 (35%) patients. SFR was 61%. The median number of general anaesthesia was 2 (min 1, max 5). Auxiliary semirigid URS, PCNL and repeat RIRS were required in 4, 6 and 5 patients, respectively. Two patients had postoperative febrile urinary tract infection (UTI) as a complication. Age was associated with post-operative febrile UTI. Presence of stones with HU lower than 700, being operated 4.9F F-URS and without UAS were associated with better SFR. CONCLUSIONS RIRS is a minimally invasive method with low complication rates in the treatment of childhood stone disease. Higher stone-free rates are obtained in low HU stones and cases in which we used 4.9 F tip F-URS.
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Affiliation(s)
- Oguzhan Kahraman
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hasan Serkan Dogan
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ahmet Asci
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tariq Asi
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Serdar Tekgul
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Mosquera L, Pietropaolo A, Brewin A, Madarriaga YQ, de Knecht EL, Jones P, Bujons A, Griffin S, Somani BK. Safety and Outcomes of using ureteric access sheath (UAS) for treatment of Pediatric renal stones: Outcomes from 2 tertiary endourology centers. Urology 2021; 157:222-226. [PMID: 33891927 DOI: 10.1016/j.urology.2021.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/03/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To look at the safety and outcomes of using ureteral access sheath (UAS) for pediatric renal stones. The use of UAS is variable in urological practice with very little clinical work on their use in pediatric kidney stone disease. PATIENTS AND METHODS Data was retrospectively collected from 2 large European tertiary endourology centers for all pediatric patients (≤16 years) with renal stones who underwent flexible ureteroscopy and lasertripsy (FURSL) via UAS. Data was collected on patient details, stone demographics and clinical outcomes of the FURSL procedure. RESULTS Forty-eight patients with a mean age of 10.7 years were treated with FURSL for a mean single and cumulative stone size of 10.4 mm and 15 mm respectively, with two-third having multiple stones and stones in the lower pole. The initial and final stone free rate (SFR) was 66.7% and 100% respectively with 1.3 procedures/patient. One patient each had intra-operative grade 1 ureteric injury and post-operative UTI, with no other injuries or complications noted. Over a mean follow-up of 17 months, no other complications were noted. CONCLUSION Ureteral access sheath is safe for treatment of pediatric renal stones with excellent outcomes and are especially useful for larger or multiple stones. While there does not seem to be any medium-term sequalae, to avoid risk of ureteral injury, we would suggest using the smallest size sheath possible. We would argue these procedures are best done in specialist high-volume endourology units for optimal results.
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Affiliation(s)
- L Mosquera
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - A Pietropaolo
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - A Brewin
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | | | | | - P Jones
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - A Bujons
- Urology Department, Fundació Puigvert, Barcelona, Spain
| | - S Griffin
- Southampton Children's Hospital NHS Trust, Southampton, United Kingdom
| | - B K Somani
- University Hospital Southampton NHS Trust, Southampton, United Kingdom.
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Chandramohan V, Siddalingaswamy PM, Ramakrishna P, Soundarya G, Manas B, Hemnath A. Retrograde intrarenal surgery for renal stones in children <5 years of age. INDIAN JOURNAL OF UROLOGY : IJU : JOURNAL OF THE UROLOGICAL SOCIETY OF INDIA 2021; 37:48-53. [PMID: 33850355 PMCID: PMC8033242 DOI: 10.4103/iju.iju_374_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/28/2020] [Accepted: 11/20/2020] [Indexed: 11/04/2022]
Abstract
Introduction There are very few studies in the literature describing retrograde intrarenal surgery (RIRS) in preschool children. We have evaluated the feasibility, stone-free rate, and complications of RIRS in children <5 years of age. Methods All children <5 years of age and stone size <2 cm (renal/proximal ureteric), who underwent RIRS at our hospital from February 2010 to May 2020 were included in this retrospective study. All children were prestented for the passive dilatation of ureter. A 7.5 Fr flexible ureterorenoscope was introduced over the ureteral access sheath (UAS) or over a guidewire. At 2 weeks, the stent was removed and at 2 months the child was evaluated for residual stones. Results A total of 62 children with 67 renal units met the inclusion criteria. The mean age was 42.11 months (4-60 months). Mean weight was 13.31 kg (6-16.3 kg). Mean stone size was 11.9 mm (7.3-18.2 mm). Majority of the stones were in pelvis (37.8%). UAS 9.5/11.5 Fr was placed in 40 (63.5%) children. Mean operative time was 55.2 min; mean hospitalization was 61 h. Four out of the 67 renal units (5.9%) required conversion to minipercutaneous nephrolithotomy in the same sitting, due to access failure. Two cases who developed post-operative fever required a change of antibiotics. Two cases required ureteroscopy for steinstrasse postoperatively. Stone-free rate at 2 months for stones size ≤2 mm was 76.3%. Conclusion Pediatric RIRS is a promising option in young children as it offers acceptable stone-free rates and a low incidence of high-grade complications. However, it requires expertise and should be offered in tertiary care centres.
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Affiliation(s)
- Vaddi Chandramohan
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India
| | - P M Siddalingaswamy
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India
| | - Paidakula Ramakrishna
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India
| | - Ganesan Soundarya
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India
| | - Babu Manas
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India
| | - Anandan Hemnath
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India
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Aljumaiah S, Allubly N, Alshammari A, Alkhamees M, Hamri SB. Small Ureteral Access Sheath in Treating Paediatric Urolithiasis: A Single Centre Experience. Res Rep Urol 2020; 12:663-668. [PMID: 33376709 PMCID: PMC7764550 DOI: 10.2147/rru.s277855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/30/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction Urolithiasis is not commonly encountered in the pediatric population. The adoption of ureteral access sheaths (UAS) facilitates the passage to the pediatric ureter and limits the harm and ureteral injury. However, the debate continues regarding whether or not to use UAS in children. Objective To assess the safety and outcomes of using UAS in the treatment of pediatric renal and ureteral stones. Study Design This was a prospective cohort study of 14 pediatric patients who underwent flexible ureteroscopy (fURS) with the use of UAS for symptomatic renal and ureteric stones. Results Of the fourteen enrolled patients, nine (64.3%) were males, and five (35.7%) were females with an average age of 9.5 years. Eleven (78.6%) of the patients were rendered stone-free. The average operative time was 55.7 min. None of the patients developed any complications. The stone-free rate was significantly higher with stone burdens of ≤10 mm (p ≤ 0.05). Conclusion The use of UAS in children facilitates the passage of a flexible ureteroscope without complications. The procedure is considered to be efficient and safe with minimal morbidity.
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Affiliation(s)
- Sahar Aljumaiah
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh 11426, Saudi Arabia
| | - Nasser Allubly
- Department of Urology, Department of Surgery, King Fahad Hufof Hospital, Al-Ahsa, Saudi Arabia
| | - Ahmad Alshammari
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh 11426, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 11426, Saudi Arabia
| | - Mohammad Alkhamees
- Department of Urology, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh 11426, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 11426, Saudi Arabia
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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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Anbarasan R, Griffin SJ, Somani BK. Outcomes and Long-Term Follow-Up with the Use of Ureteral Access Sheath for Pediatric Ureteroscopy and Stone Treatment: Results from a Tertiary Endourology Center. J Endourol 2019; 33:79-83. [PMID: 30511885 DOI: 10.1089/end.2018.0448] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The aim of this study was to retrospectively analyze outcomes of flexible ureteroscopy and laser fragmentation (FURSL) of renal stones with the use of ureteral access sheath (UAS) in the pediatric population. MATERIALS AND METHODS We retrospectively collected data between January 2011 and January 2018 for patient demographics, stone characteristics, and outcomes in 21 children who underwent FURSL with the use of UAS. RESULTS Twenty-one patients (10 boys and 11 girls) with a mean age of 11.8 years (range: 2-16 years) underwent FURSL using an access sheath. The stone location was in the lower pole in 13 patients (62%) with 12 patients (57%) having multiple stones. A 9.5F (35 cm) Cook Flexor UAS was used in all cases. The mean and overall stone size was 12 mm (range: 5-30 mm) and 15.4 mm (range: 5-35 mm), respectively. Preoperative stent was present in 8(38%) patients, and a postoperative stent or overnight ureteric catheter was inserted in 14 patients (67%). Thirty-one procedures (average: 1.5/patient) were needed to achieve a stone-free rate of 95%. There were no procedural or long-term complications noted over a mean follow-up of 26 months (4-37 months). CONCLUSION The use of UAS in the treatment of pediatric renal stones is safe and feasible with good outcomes and without any long-term sequelae.
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Affiliation(s)
- Ravindar Anbarasan
- 1 Department of Paediatric Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Stephen J Griffin
- 1 Department of Paediatric Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Bhaskar K Somani
- 2 Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Çitamak B, Mammadov E, Kahraman O, Ceylan T, Doğan HS, Tekgül S. Semi-Rigid Ureteroscopy Should Not Be the First Option for Proximal Ureteral Stones in Children. J Endourol 2018; 32:1028-1032. [DOI: 10.1089/end.2017.0925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Burak Çitamak
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Emin Mammadov
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Oğuzhan Kahraman
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Taner Ceylan
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hasan Serkan Doğan
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Serdar Tekgül
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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Flexible ureterorenoscopy to treat upper urinary tract stones in children. Urolithiasis 2018; 48:57-61. [PMID: 30370467 DOI: 10.1007/s00240-018-1083-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/21/2018] [Indexed: 10/28/2022]
Abstract
Development of surgical expertise and technology has affected the way renal tract stones are treated. Our hypothesis was that flexible ureteroscopy (FURS) for upper tract stones in children produces good results. Our outcomes were reviewed. A retrospective case note review was performed for children with upper tract calculi who were treated by FURS. There were 56 stone episodes in 36 patients. Median age was 10.6 years. Stones were 3-23 mm (median 8 mm); 64.3% had multiple calculi. Median follow-up was for 17.1 months. After the first FURS there was stone clearance in 42/56 (75%). Although there were no immediate complications, two required re-admission; one with stent symptoms, the other with urinary infection. A second FURS was performed in 11, bringing the cumulative clearance to 89%, although this was often done as "another look" before stent removal. There was no statistically significant difference in stone clearance after first FURS for those with single stones (81.0%) compared to those with multiple stones (72.2%). Clearance rates of more than 70% after first FURS were achieved with stones of up to 17 mm. Unexpected disease was found and treated during FURS in 9 (16.1%) children. FURS is safe in children and good clearance rates are achieved. Multiple stones at different sites may be treated during the same treatment. In addition, FURS allows diagnosis and treatment of unexpected problems.
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The effect of surgeon versus technologist control of fluoroscopy on radiation exposure during pediatric ureteroscopy: A randomized trial. J Pediatr Urol 2018; 14:334.e1-334.e8. [PMID: 30257794 DOI: 10.1016/j.jpurol.2018.04.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/28/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Fluoroscopy is commonly used during pediatric ureteroscopy (PURS) for urolithiasis, and the most important contributor to overall radiation exposure is fluoroscopy time (FT). One factor that may impact FT is who controls activation of the fluoroscope: the urologist (with a foot pedal) or the radiation technologist (as directed by the urologist). While there are plausible reasons to believe that either approach may lead to reduced FT, there are no systematic investigations of this question. We sought to compare FT with surgeon-control versus technologist control during PURS for urolithiasis. METHODS We conducted a randomized controlled trial (Clinicaltrials.gov ID number: NCT02224287). Institutional Review Board approval was sought and obtained for this study. All subjects (or their legal guardians) provided informed consent. Each patient (age 5-26 years) was randomized to surgeon- or technologist-controlled fluoroscope activation. Block randomization was stratified by the surgeon. For technologist control, the surgeon verbally directed the technologist to activate the fluoroscope. For surgeon control, a foot pedal was used by the surgeon. The technologist controlled c-arm positioning, settings, and movement. The primary outcome was total FT for the procedure. Secondary outcomes included radiation exposure (entrance surface air kerma [ESAK] mGy). We also analyzed clinical and procedural predictors of FT and exposure. Mixed linear models accounting for clustering by surgeon were developed. RESULTS Seventy-three procedures (5 surgeons) were included. The number of procedures per surgeon ranged from seven to 36. Forty-three percent were pre-stented. Thirty-one procedures were left side, 35 were right side, and seven were bilateral. Stones were treated in 71% of procedures (21% laser, 14% basket, and 65% laser/basket). Stone locations were distal ureter (11.5%), proximal/mid-ureter (8%), renal (69%), and ureteral/renal (11.5%). An access sheath was used in 77%. Median stone size was 8.0 mm (range 2.0-20.0). Median FT in the surgeon control group was 0.5 min (range 0.01-6.10) versus 0.55 min (range 0.10-5.50) in the technologist-control group (p = 0.284). Median ESAK in the surgeon control group was 46.02 mGy (range 5.44-3236.80) versus 46.99 mGy (range: 0.17-1039.31) in the technologist-control group (p = 0.362). Other factors associated with lower FT on univariate analysis included female sex (p = 0.015), no prior urologic surgeries (p = 0.041), shorter surgery (p = 0.011), and no access sheath (p = 0.006). On multivariable analysis only female sex (p = 0.017) and no access sheath (p = 0.049) remained significant. There was significant variation among surgeons (p < 0.0001); individual surgeon median FT ranged from 0.40 to 2.95 min. CONCLUSIONS Fluoroscopy time and radiation exposure are similar whether the surgeon or technologist controls fluoroscope activation. Other strategies to reduce exposure might focus on surgeon-specific factors, given the significant variation between surgeons.
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Berrettini A, Boeri L, Montanari E, Mogiatti M, Acquati P, De Lorenzis E, Gallioli A, De Marco EA, Minoli DG, Manzoni G. Retrograde intrarenal surgery using ureteral access sheaths is a safe and effective treatment for renal stones in children weighing <20 kg. J Pediatr Urol 2018; 14:59.e1-59.e6. [PMID: 29195830 DOI: 10.1016/j.jpurol.2017.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 09/10/2017] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Surgical treatment of pediatric kidney stones has changed dramatically in recent years because of the miniaturization of surgical instruments and the availability of intracorporeal lithotripters. The retrograde intrarenal surgery (RIRS) technique is nowadays considered an effective and safe procedure but studies in very young children are lacking and use of a ureteral access sheath (UAS) has also been debated. OBJECTIVE To assess safety and efficacy of RIRS using UAS in children weighing < 20 kg. MATERIALS AND METHODS Data from 13 children weighing <20 kg who underwent RIRS for renal stones were collected. A Double-J stent was positioned 14 days before surgery. Demographics, stone location, stone number and composition, stone-free status (SFS) and complications were evaluated. Descriptive statistics were applied to describe the cohort. RESULTS Thirteen patients, age 3.91 ± 1.8 years (mean ± SD), underwent 16 RIRS. Mean patient weight and stone burden were 14.88 ± 3.81 kg (range 10-20 kg) and 15.5 ± 3.8 mm (median 16 mm), respectively. A UAS was used in 15 out of 16 (93.8%) procedures. SFS was achieved in 81.3% of cases after the first procedure and 100% after auxiliary procedures. Postoperative urinary tract infections with fever (Clavien II) were observed in two (12.5%) patients. Hydrocalyx (Clavien IIIb) was noted in one (6.3%) patient. Patients with stones located in the lower polar calices (p = 0.024) and with mixed composition (p = 0.036) had a greater prevalence of complications than those with calculi of other compositions located in other sites. After a mean follow-up of 22.4 months no cases of ureteral strictures or vesicoureteral reflux were observed (Table). DISCUSSION The current findings support previous evidence showing safety and efficacy of RIRS with use of the UAS in pre-stented very young children. In our experience RIRS seems to be an effective and safe option with a stone-free rate of 81.3% and only 1 severe complication (Clavien-Dindo grade IIIb) and no long-term complications. This study is, to date, the first to examine the safety and efficacy of RIRS using UAS for the treatment of intrarenal stones in a selected cohort of pre-school patients weighing <20 kg. CONCLUSIONS RIRS using UAS is an effective and safe procedure for treating kidney stones in pre-school patients weighing <20 kg without complications at both short and long term follow up. Stones of mixed composition located in the lower polar calices are associated with a greater risk of postoperative complications.
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Affiliation(s)
- Alfredo Berrettini
- U.O.C. Urologia Pediatrica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Luca Boeri
- U.O.C. Urologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Emanuele Montanari
- U.O.C. Urologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Mirella Mogiatti
- U.O.C. Urologia Pediatrica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pietro Acquati
- U.O.C. Urologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Elisa De Lorenzis
- U.O.C. Urologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Andrea Gallioli
- U.O.C. Urologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Erika Adalgisa De Marco
- U.O.C. Urologia Pediatrica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Guido Minoli
- U.O.C. Urologia Pediatrica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianantonio Manzoni
- U.O.C. Urologia Pediatrica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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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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Chen Y, Deng T, Duan X, Zhu W, Zeng G. Percutaneous nephrolithotomy versus retrograde intrarenal surgery for pediatric patients with upper urinary stones: a systematic review and meta-analysis. Urolithiasis 2018; 47:189-199. [DOI: 10.1007/s00240-018-1039-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 01/10/2018] [Indexed: 12/29/2022]
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Kucukdurmaz F, Efe E, Sahinkanat T, Amasyalı AS, Resim S. Ureteroscopy With Holmium:Yag Laser Lithotripsy for Ureteral Stones in Preschool Children: Analysis of the Factors Affecting the Complications and Success. Urology 2018; 111:162-167. [DOI: 10.1016/j.urology.2017.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/24/2017] [Accepted: 09/06/2017] [Indexed: 12/23/2022]
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Sen H, Seckiner I, Bayrak O, Dogan K, Erturhan S. A comparison of micro-PERC and retrograde intrarenal surgery results in pediatric patients with renal stones. J Pediatr Urol 2017; 13:619.e1-619.e5. [PMID: 28679474 DOI: 10.1016/j.jpurol.2017.04.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 04/02/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION With advancements in endoscopic surgery, open surgical techniques for urinary system stones have paved the way for the application of less invasive treatment modalities in patients with pediatric kidney stone disease. These treatment options include extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS). OBJECTIVE We aimed to compare the efficacy and safety of RIRS and micro-PCNL techniques in the surgical treatment of kidney stones in pediatric patients. STUDY DESIGN A total of 48 pediatric patients, who underwent RIRS or micro-PERC for pediatric kidney stone disease, were retrospectively analyzed. Urinalysis, urine culture, serum creatinine (Cr), blood urea nitrogen (BUN), calcium, phosphorus, parathyroid hormone, 24-hour urine sample, complete blood count (CBC), urinary system X-ray, kidney ureter bladder (KUB), and urinary system ultrasonography (USG) test results were evaluated prior to the procedure. Intravenous pyelography (IVP), non-contrast computed tomography (CT), and renal scintigraphy evaluations were also performed, if necessary. The patients were divided into two groups: micro-PERC group (n = 25) and RIRS group (n = 23). Data relating to the duration of the operation, duration of fluoroscopy, length of hospitalization, complication rates, and stone-free rates were recorded. RESULTS The mean ages of the micro-PERC and RIRS groups were 4 ± 2.3 and 10.9 ± 3 years, respectively (p = 0.001). However, the mean stone sizes were 12.2 ± 2.8 and 13.7 ± 3.5 mm, respectively (p > 0.05). The mean duration of operation was 75.1 ± 18.9 min in the micro-PERC group and 62.3 ± 15.3 min in the RIRS group (p > 0.05). In addition, the mean duration of fluoroscopy was 115 ± 35.4 s in the micro-PERC group and 39.9 ± 15.3 s in the RIRS group. The stone-free rates in the micro-PERC and RIRS groups following the procedure were reported to be 84% (21/25) and 82.6% (19/23), respectively (p > 0.05). In terms of the degree of preoperative hydronephrosis between the groups, the rates of mild and moderate-severe disease were 76% (19 out of 25) and 24% (6 out of 25), and 69.5% (16 out of 23) and 30.4% (7 out of 23) in the micro-PERC and RIRS groups, respectively. CONCLUSION In recent years, technological developments in minimally invasive procedures, such as micro-PERC and RIRS, have facilitated choices made by urologists in the effective and safe first-line treatment in pediatric patients.
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Affiliation(s)
- Haluk Sen
- Department of Urology, School of Medicine, Gaziantep University, Gaziantep, Turkey.
| | - Ilker Seckiner
- Department of Urology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Omer Bayrak
- Department of Urology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Kazim Dogan
- Department of Urology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Sakip Erturhan
- Department of Urology, School of Medicine, Gaziantep University, Gaziantep, Turkey
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Diamand R, Idrissi-Kaitouni M, Coppens E, Roumeguère T, Legrand F. [Evaluation of stone size before flexible ureteroscopy: Which measurement is best?]. Prog Urol 2017; 28:62-70. [PMID: 29102376 DOI: 10.1016/j.purol.2017.09.014] [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: 04/24/2017] [Revised: 08/28/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To retrospectively assess the clinical utility in ureteroscopy (URS) planning of radiological parameters as predictor of stone-free status after a single flexible ureteroscopy. MATERIAL Sixty-seven patients with renal stones treated by flexible URS were retrospectively evaluated. To assess the clinical utility of radiological parameters, relationships between stone-free (SF) status and stone burden (maximal diameter, calculated area, calculated volume, cumulative diameter, and tridimentionnal volume [V3D]) were analyzed using the area under the receiver operating characteristics curve and logistic regression. RESULTS Maximal diameter (AUC=0.75), calculated area (AUC 0.79), calculated volume (AUC=0.79), cumulative diameter (AUC=0.80) and tridimensional volume (AUC=0.82) revealed ability to predict SF status after URS. CONCLUSION Stone burden evaluation is critical in predicting SF status after a single URS. Planar and volumetric measurements showed equal ability to predict SF status. V3D is more accurate but diameter measurement remains easier in clinical practice. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- R Diamand
- Service d'urologie, cliniques universitaires de Bruxelles, hôpital Erasme-ULB, 808, route de Lennik, 1070 Bruxelles, Belgique
| | - M Idrissi-Kaitouni
- Service d'urologie, cliniques universitaires de Bruxelles, hôpital Erasme-ULB, 808, route de Lennik, 1070 Bruxelles, Belgique
| | - E Coppens
- Service de radiologie, cliniques universitaires de Bruxelles, hôpital Erasme-ULB, Bruxelles, Belgique
| | - T Roumeguère
- Service d'urologie, cliniques universitaires de Bruxelles, hôpital Erasme-ULB, 808, route de Lennik, 1070 Bruxelles, Belgique
| | - F Legrand
- Service d'urologie, cliniques universitaires de Bruxelles, hôpital Erasme-ULB, 808, route de Lennik, 1070 Bruxelles, Belgique.
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Ureteroscopy for Stone Disease in Paediatric Population is Safe and Effective in Medium-Volume and High-Volume Centres: Evidence from a Systematic Review. Curr Urol Rep 2017; 18:92. [PMID: 29046982 PMCID: PMC5693963 DOI: 10.1007/s11934-017-0742-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Purpose of Review The incidence of urinary stone disease among the paediatric population is increasing. Whilst there has been a rise in the number of original studies published on ureteroscopy (URS) in children, critical review still remains under-reported. Recent Findings A Cochrane style systematic review was performed to identify all original articles on URS (minimum of 25 cases) for stone disease in paediatric patients between Jan. 1996 and Dec. 2016. Based on the number of reported cases, centres were divided into medium (25–49 cases) and high (≥ 50 cases) volume studies. Thirty-four studies (2758 children) satisfied our search criteria and were included in this review. The mean stone size was 8.6 mm with an overall stone-free rate (SFR) of 90.4% (range 58–100). Medium-volume centres reported a mean SFR of 94.1% (range 87.5–100), whilst high-volume centres reported a mean SFR of 88.1% (range 58–98.5). Mean number of sessions to achieve stone-free status in medium-volume and high-volume groups was 1.1 and 1.2 procedures/patient respectively. The overall complication rate was 11.1% (327/2994). Breakdown by Clavien grade was as follows: Clavien I 69% and Clavien II/III 31%. There were no Clavien IV/V complications, and no mortality was recorded across any of the studies. The overall failure to access rate was 2.5% (76/2944). Medium-volume and high-volume studies had overall complication rates of 6.9% (37/530) and 12.1% (287/2222) respectively, but there was no significant difference in major or minor complications between these two groups. Summary Ureteroscopy is a safe and effective treatment for paediatric stone disease. Medium-volume centres can achieve equally high SFRs and safety profiles as high-volume centres. Despite the rarity of paediatric stone disease, our findings might increase the uptake of paediatric URS procedures.
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Kılıç Ö, Akand M, Van Cleynenbreugel B. Retrograde intrarenal surgery for renal stones - Part 2. Turk J Urol 2017; 43:252-260. [PMID: 28861294 DOI: 10.5152/tud.2017.22697] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 12/17/2022]
Abstract
Retrograde intrarenal surgery (RIRS) has become an effective and safe treatment modality in the management of urinary system stone disease. Recent developments and innovations in the flexible ureterorenoscope and auxiliary equipment have made this procedure easier and more effective with increased success rates. RIRS can be used as a primary treatment in patients with renal stones smaller than 2 cm, prior unsuccessful shock wave lithotripsy, infundibular stenosis, renoureteral malformation, skeletal-muscular deformity, bleeding diathesis and obese patients. In the second part of this detailed review for RIRS, effect of stone composition on success rate, preoperative assessment of stone-free rate, the cost of this modality, education for RIRS, fluoroscopy use, the current role of RIRS in the treatment of various urolithiasis types and special conditions, and combined treatment methods are discussed with up-to-date literature.
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Affiliation(s)
- Özcan Kılıç
- Department of Urology, Selçuk University School of Medicine, Konya, Turkey
| | - Murat Akand
- Department of Urology, Selçuk University School of Medicine, Konya, Turkey
| | - Ben Van Cleynenbreugel
- Department of Urology, Katholieke Universiteit Leuven School of Medicine, Leuven, Belgium
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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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Utanğaç MM, Sancaktutar AA, Tepeler A. Micro-ureteroscopy for the treatment of distal ureteral calculi in children. J Pediatr Surg 2017; 52:512-516. [PMID: 27912973 DOI: 10.1016/j.jpedsurg.2016.11.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/25/2016] [Accepted: 11/04/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of this study was to demonstrate the efficacy and safety of micro-ureteroscopy (micro-URS) in the management of distal ureteral stones in the pediatric population. MATERIALS AND METHODS A total of 11 children, who had undergone micro-URS between September 2015 and April 2016 with the indication of distal ureteral calculi in two referral centers, were retrospectively evaluated. The procedures were performed with the patient in the lithotomy position under general anesthesia using the standard URS technique with a micro-ureteroscope that has a caliber of 4.85 Fr all along its length. Demographics, perioperative data, and outcomes were assessed. RESULTS Right (n=6) and left (n=8) ureteral stones were detected in the respective number of patients. The mean age of the children was calculated as 55.1months (range, 6-161months). The median stone size was 10.5mm (range, 6-24mm). The median operative time was 36.8min (range, 23-68min). A double 3 stent was implanted in 3 of 11 patients because of severe edema. As a postoperative complication mild hematuria (Clavien grade 1) was observed in one case and resolved spontaneously. Intraoperative minor or major complication did not occur in any of the cases. The mean hospitalization time was determined as 21.4h (range, 10-28h). Stone-free status was accomplished in all patients in the final assessment. CONCLUSION The outcomes of our series show that micro-URS can be used safely and effectively in the treatment of pediatric distal ureteral stones. Further prospective and comparative studies comparing instruments of different size are warranted.
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Affiliation(s)
| | | | - Abdulkadir Tepeler
- Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Guven S, Basiri A, Varshney AK, Aridogan IA, Miura H, White M, Kilinc M, de la Rosette J. Examining Pediatric Cases From the Clinical Research Office of the Endourological Society Ureteroscopy Global Study. Urology 2017; 101:31-37. [DOI: 10.1016/j.urology.2016.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/10/2016] [Accepted: 11/15/2016] [Indexed: 02/08/2023]
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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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Pelit ES, Atis G, Kati B, Akin Y, Çiftçi H, Culpan M, Yeni E, Caskurlu T. Comparison of Mini-percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery in Preschool-aged Children. Urology 2016; 101:21-25. [PMID: 27818164 DOI: 10.1016/j.urology.2016.10.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To compare the outcomes of mini-percutaneous nephrolithotomy (m-PCNL) and retrograde intrarenal surgery (RIRS) in treating renal stones in preschool-aged children. MATERIALS AND METHODS Forty-five patients treated with m-PCNL and 32 patients treated with RIRS for renal stones were compared retrospectively. The operative and postoperative outcomes of both groups were analyzed retrospectively. RESULTS The mean age and gender were similar between the groups. The mean stone size was 19.30 ± 4.21 mm for the RIRS group and 21.06 ± 5.61 mm for the PCNL group (P = .720). The mean operative times, fluoroscopy times, and hospitalization times were statistically higher in the PCNL group. The stone-free rates (SFRs) after a single procedure were 84.4% in the PCNL group and 75% in the RIRS group (P = .036). After auxiliary procedures, the overall SFRs reached 91.1% for the PCNL group and 90.6% for the RIRS group (P = .081). No major complications were observed for both groups. Minor complication (Clavien 1-3) rates were 15.5% and 12.5% for the PCNL and RIRC group, respectively (P = .385). CONCLUSION RIRS has some advantages over PCNL such as shorter hospitalization times, shorter fluoroscopy times, and shorter operative time in treating renal stones. However, PCNL achieves higher SFR after a single session.
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Affiliation(s)
- Eyyup Sabri Pelit
- Department of Urology, Faculty of Medicine, Harran University, Sanliurfa, Turkey.
| | - Gökhan Atis
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Bülent Kati
- Department of Urology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Yiğit Akin
- Department of Urology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Halil Çiftçi
- Department of Urology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Meftun Culpan
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ercan Yeni
- Department of Urology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Turhan Caskurlu
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Gokce MI, Telli O, Akinci A, Esen B, Suer E, Ozkidik M, Hajiyev P, Soygur T, Burgu B. Effect of Prestenting on Success and Complication Rates of Ureterorenoscopy in Pediatric Population. J Endourol 2016; 30:850-5. [DOI: 10.1089/end.2016.0201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Mehmet Ilker Gokce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Onur Telli
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Aykut Akinci
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Baris Esen
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Evren Suer
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Mete Ozkidik
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Perviz Hajiyev
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Tarkan Soygur
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Berk Burgu
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
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Gökce MI, Telli O, Özkıdık M, Akıncı A, Hajıyev P, Soygür T, Burgu B. Evaluation of Postoperative Hydronephrosis Following Ureteroscopy in Pediatric Population: Incidence and Predictors. Urology 2016; 93:164-9. [DOI: 10.1016/j.urology.2016.02.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 01/20/2016] [Accepted: 02/02/2016] [Indexed: 11/17/2022]
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Baş O, Dede O, Aydogmus Y, Utangaç M, Yikilmaz TN, Damar E, Nalbant İ, Bozkurt ÖF. Comparison of Retrograde Intrarenal Surgery and Micro-Percutaneous Nephrolithotomy in Moderately Sized Pediatric Kidney Stones. J Endourol 2016; 30:765-70. [PMID: 26983791 DOI: 10.1089/end.2016.0043] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To compare the effectiveness and reliability of retrograde intrarenal surgery (RIRS) and micro-percutaneous nephrolithotomy (micro-perc) for the management of kidney stones in pediatric patients. MATERIALS AND METHODS A retrospective analysis was made of pediatric patients aged <18 years with kidney stones that ranged from 10 to 20 mm in size, who underwent RIRS (n = 36) or micro-perc (n = 45) in referral centers. RESULTS In the RIRS group, the mean age of patients was 8.39 ± 4.72 years and in the micro-perc group, it was 5.62 ± 4.50 years (p = 0.01). The mean stone size was 12.80 ± 3.03 mm in the RIRS group and 13.97 ± 3.46 mm in the micro-perc group (p = 0.189). The success rate was 86.2% (n = 31) in the RIRS group and 80.0% (n = 36) in the micro-perc group (p = 0.47). The mean complication rate was 16.6% and 13.3% in the RIRS and micro-perc groups, respectively (p = 0.675). Hospital stay and radiation exposure were significantly lower in the RIRS group (all p < 0.001). The mean anesthesia session was 1.94 in the RIRS group and 1.26 in the micro-perc group (p < 0.001). The mean hemoglobin drop was 0.53 ± 0.87 g/dL in the micro-perc group, and none of the cases required blood transfusion. CONCLUSION The results of this study suggested that micro-perc and RIRS were highly effective methods for the treatment of moderately sized renal stones in children, with comparable success and complication rates. Patients and their parents should be informed about the currently available treatment options, and of their efficacy and safety. However, further clinical trials are needed to support these results.
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Affiliation(s)
- Okan Baş
- 1 Department of Urology, Diskapi Yildirim Beyazid Training and Research Hospital , Ankara, Turkey
| | - Onur Dede
- 2 Department of Urology, Faculty of Medicine, Dicle University , Diyarbakır, Turkey
| | - Yasin Aydogmus
- 3 Department of Urology, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital , Ministry of Health, Ankara, Turkey
| | - Mazhar Utangaç
- 2 Department of Urology, Faculty of Medicine, Dicle University , Diyarbakır, Turkey
| | - Taha Numan Yikilmaz
- 4 Department of Urology, Urology Residency Training Program , Ankara, Turkey
| | - Erman Damar
- 4 Department of Urology, Urology Residency Training Program , Ankara, Turkey
| | - İsmail Nalbant
- 1 Department of Urology, Diskapi Yildirim Beyazid Training and Research Hospital , Ankara, Turkey
| | - Ömer Faruk Bozkurt
- 4 Department of Urology, Urology Residency Training Program , Ankara, Turkey
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Tejwani R, Wang HHS, Wolf S, Wiener JS, Routh JC. Outcomes of Shock Wave Lithotripsy and Ureteroscopy for Treatment of Pediatric Urolithiasis. J Urol 2016; 196:196-201. [PMID: 26997313 DOI: 10.1016/j.juro.2016.02.2975] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Shock wave lithotripsy has been commonly used to treat children with renal and ureteral calculi but recently ureteroscopy has been used more frequently. We examined postoperative outcomes from these 2 modalities in children. MATERIALS AND METHODS We reviewed linked inpatient, ambulatory surgery and emergency department data from 2007 to 2010 for 5 states to identify pediatric admissions for renal/ureteral calculi treated with shock wave lithotripsy or ureteroscopy. Unplanned readmissions, additional procedures and emergency room visits were extracted. Multivariate logistic regression using generalized estimating equations to adjust for hospital level clustering was performed. RESULTS We identified 2,281 admissions (1,087 for shock wave lithotripsy and 1,194 for ureteroscopy). Ages of patients undergoing ureteroscopy and those undergoing shock wave lithotripsy were similar (median 17.0 years for both cohorts, p = 0.001) but patients were more likely to be female (63.4% vs 54.7%, p <0.0001), to be privately insured (69.8% vs 62.2%, p <0.0005) and to have a ureteral stone (81.0% vs 34.8%, p <0.0001). Patients undergoing ureteroscopy demonstrated a lower rate of additional stone related procedures within 12 months (13.6% vs 18.8%, p <0.0007) but a higher rate of readmissions (10.8% vs 6.3%, p <0.0002) and emergency room visits (7.9% vs 4.9%, p <0.0036) within 30 days postoperatively. On multivariable analysis patients undergoing ureteroscopy were nearly twice as likely to visit an emergency room within 30 days of the procedure (OR 1.97, p <0.001) and to be readmitted to inpatient services (OR 1.71, p <0.01). CONCLUSIONS Ureteroscopy is now used more commonly than shock wave lithotripsy for initial pediatric stone intervention. Although repeat treatment rates did not differ between procedures, ureteroscopy patients were more likely to be seen at an emergency room or hospitalized within 30 days of the initial procedure.
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Affiliation(s)
- Rohit Tejwani
- Duke University School of Medicine, Durham, North Carolina
| | - Hsin-Hsiao S Wang
- Duke University School of Medicine, Durham, North Carolina; Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Steven Wolf
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - John S Wiener
- Duke University School of Medicine, Durham, North Carolina; Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jonathan C Routh
- Duke University School of Medicine, Durham, North Carolina; Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
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Caballero-Romeu JP, Budia-Alba A, Galan-Llopis JA, Montoya-Lirola MD, García-Tabar PJ, Galiano-Baena JF, Albertos-Mira-Marcelí N, Gonzalvez-Piñera J. Microureteroscopy in Children: Two First Cases. J Endourol Case Rep 2016; 2:44-7. [PMID: 27579414 PMCID: PMC4996592 DOI: 10.1089/cren.2016.0005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Urinary stones disease is becoming more common not only in adults but also in children. Most cases are resolved with extracorporeal shock wave lithotripsy, but miniaturization of endoscopes has increased the use of ureteroscopy in resolving ureteral stones, most notably in children. CASE PRESENTATION This presentation focuses on two cases of microureteroscopy. In both cases, the presence of lithiasis in the pelvic ureter was suspected to be the cause of ureter hydronephrosis, and a microureteroscopy was performed for treatment purposes. MicroPerc set 4.85F sheath was used to explore the pelvic ureter, thus avoiding the need to dilate the ureteral meatus or having to use the safety guide. Patients did not require a postoperative stent and were discharged within 24 hours of the procedure. CONCLUSION Use of microureteroscopy proved satisfactory in the two cases of children and it allows diagnosis and treatment of ureteral pathology in pediatric patients.
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Affiliation(s)
| | - Alberto Budia-Alba
- Department of Urology, "La Fe" Polytechnic University Hospital in Valencia , Valencia, Spain
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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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Nason GJ, Headon R, Burke MJ, Aslam A, Kelly ME, Giri SK, Flood HD. Are Adult Ureteroscopes Safe in the Management of Urolithiasis in a Pediatric Population? Curr Urol 2015. [PMID: 26195959 DOI: 10.1159/000365684] [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] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Debate remains regarding the optimal caliber of ureteroscopes in the management of pediatric urolithiasis, ranging from pediatric scopes to standard scopes. The aim of this study was to assess the safety and efficacy of stone management in a pediatric population using standard adult ureteroscopes. METHODS A retrospective review of all ureteroscopic procedures in patients under the age of 16 years was carried out. Standard adult 7.5 French semi-rigid and 6 French flexible ureteroscopes were used. RESULTS During the study period, 8 patients underwent 21 ureteroscopic procedures. Two patients had rigid ureteroscopy, seven had flexible ureterorenoscopy and one had a subsequent open procedure. No patients required ureteric dilation. Double J ureteric stents were utilized in 7 patients. There were no complications. All patients required extra corporeal shock wave lithotripsy. Stone clearance was achieved in all patients. CONCLUSION Our series demonstrates that, in skilled hands, adult ureteroscopes can be use safely for the treatment of urolithiasis in pediatric patients.
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Affiliation(s)
- Gregory J Nason
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - Rebecca Headon
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - Matthew J Burke
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - Asadullah Aslam
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - Michael E Kelly
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - Subhasis K Giri
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - Hugh D Flood
- Department of Urology, University Hospital Limerick, Limerick, Ireland
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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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Treatment alternatives for urinary system stone disease in preschool aged children: results of 616 cases. J Pediatr Urol 2015; 11:34.e1-5. [PMID: 25697981 DOI: 10.1016/j.jpurol.2014.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 11/10/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The treatment of stone disease is mostly similar in those adult and children. The standard treatment procedures are as follows: extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS), percutaneous nephrolithotomy (PCNL), and laparoscopic surgery in selected cases. Open surgery (OS) is another option particularly in such cases with anatomic abnormalities of urinary tract. OBJECTIVE The present study aims to provide comparative results of stone removal procedures in preschool aged patients who were diagnosed with urinary system stone disease. STUDY DESIGN The retrospective data of 616 pediatric preschool patients consulted with urinary system stone disease between January 2009 and July 2013 were evaluated. All patients were evaluated with Kidney-Ureter-Bladder (KUB) Xray and abdomino-pelvic ultrasound. Intravenous pyelography, unenhanced computed tomography (CT), and renal scintigraphy were performed when needed. Patients were categorized according to the procedures as: Group ESWL, Group URS, Group PNL, Group micro-PNL and Group OS. Following the procedures, opaque residual stones were evaluated with KUB Xray, and non-opaque residual stones were evaluated with unenhanced CT. RESULTS In groups (ESWL, URS, PNL, micro-PNL, OS), the stone-free rate was 68%, 66%, 85%, 100% and 94 %, respectively. The stone analysis were observed as, calcium oxalate in 377 patients (61.2%), uric acid in 106 patients (17.2%), infection stone in 73 patients (11.8 %), and cysteine in 60 patients (9.7%). There was no significant difference in stone analysis between the groups (p > 0.05) (Table). DISCUSSION Minimally invasive procedures are frequently preferred in the pediatric age urinary system stone disease. These procedures are ESWL, PCNL, and ureteroscopy [10,11]. Open surgery is reserved only for rare cases [12]. Similarly the current literature, 18 (2.9%) patients had anatomical anomaly and had high complex stone burden were treated with open surgery in our study. ESWL is a preferred treatment method for pediatric urolithiasis patients with a stone size <20 mm, and the rate of stone-free after ESWL ranges between 57 and 92% [13]. In a study showed the effect of stone size on the success rate in ESWL, the success rate was 91% for stones <10 mm, and 75% for stones >10 mm [15]. In the present study, stone-free rate was noted as 68% on 15 mm or lower stone size. PNL is commonly used to treat stone disease in preschool children [18-20]. In the beginning, urologists hesitated to use instruments suited for adults in case of pediatric kidneys. While some authors accept a cut-off value of 24 F for tract dilatation in the pediatric age, Desai et al. recommended a threshold value <22 F [19,21]. In our study, we used adult PNL instruments in the early period, whereas mini-PERC was performed in the later years. The success rate in PNL group was found as 85%. In recent years, the micro-PNL procedure has been developed to reduce/prevent the complications of standard PNL. In our study, the success rate was calculated as 100% with micro-PNL. This study has certain limitations. The major limitation of our study is its retrospective nature. In addition, sample size of micro-PNL group is fewer than other groups. CONCLUSION The goal of kidney stone treatment is to achieve minimal kidney damage and a high success rate. Thus, the procedures are important in the pediatric age group where life expectancy is high, and particularly in the preschool age group.
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Ishii H, Griffin S, Somani BK. Ureteroscopy for stone disease in the paediatric population: a systematic review. BJU Int 2015; 115:867-73. [DOI: 10.1111/bju.12927] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hiro Ishii
- Department of Urology; University Hospital Southampton NHS Trust; Southampton UK
| | - Stephen Griffin
- Department of Paediatric Surgery; University Hospital Southampton NHS Trust; Southampton UK
| | - Bhaskar K. Somani
- Department of Urology; University Hospital Southampton NHS Trust; Southampton UK
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Ureteroscopy for treatment of upper urinary tract stones in children: technical considerations. Curr Urol Rep 2014; 15:407. [PMID: 24658833 DOI: 10.1007/s11934-014-0407-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The incidence of pediatric urolithiasis is increasing. While many smaller stones may pass spontaneously, surgical therapy is sometimes warranted. Surgical options include shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, and open surgery. Ureteroscopy represents a minimally invasive approach, and it is increasingly being used to treat pediatric upper tract calculi. Ureteroscopy is performed under anesthesia and fluoroscopic guidance, with basket extraction or lithotripsy of the calculi. Technical considerations include active or passive ureteral dilatation, the use of ureteral access sheaths for larger stone burdens, and post-operative stent placement. The current pediatric literature suggests high success rates (equal to or surpassing shock wave lithotripsy) and low complication rates. However, concerns remain regarding feasibility in patients with variant anatomies and risk due to intra-operative radiation exposure.
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Ishii H, Griffin S, Somani BK. Flexible ureteroscopy and lasertripsy (FURSL) for paediatric renal calculi: results from a systematic review. J Pediatr Urol 2014; 10:1020-5. [PMID: 25241397 DOI: 10.1016/j.jpurol.2014.08.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 08/06/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To understand the role, safety and efficacy of flexible ureterorenoscopy and lasertripsy (FURSL) for paediatric renal stones. MATERIAL AND METHODS A systematic review was conducted using studies identified by a literature search between January 1990 and March 2014. All English language articles reporting on a minimum of five patients≤18-years old, treated with flexible ureteroscopy and lasertripsy for stone disease were included. RESULTS A total of six studies (282 patients) were reported, with a mean age of 7.3 years (range 0.25-17 years). The stone sizes ranged from 1 to 30 mm. The mean stone-free rate across the three studies was 85.5% (range 58.0-93.0%) after initial ureteroscopy, with a postoperative stent inserted in 81.8% (range 66.7-98.0%). There were a total of 35 complications (12.4%), with the most severe complication being a Clavien class III (five ureteral injuries, one urinoma). There were no deaths in any of the studies. CONCLUSION The present review shows that FURSL for management of renal calculi in the paediatric population is an effective and safe procedure. To ensure that outcomes keep on improving, these procedures should be undertaken by experienced surgeons who are familiar with the difficulties encountered in the paediatric population.
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Affiliation(s)
- H Ishii
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
| | - S Griffin
- Department of Paediatric Surgery, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK.
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Adanur S, Aydin HR, Ozkaya F, Ziypak T, Polat O. Holmium laser lithotripsy with semi-rigid ureteroscopy: a first-choice treatment for impacted ureteral stones in children? Med Sci Monit 2014; 20:2373-9. [PMID: 25415256 PMCID: PMC4250031 DOI: 10.12659/msm.891173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background We aimed to assess the effectiveness of semi-rigid ureteroscopy and holmium laser lithotripsy in the treatment of impacted ureteral stones in children. Material/Methods We evaluated a total of 32 children under the age of 18 years treated with ureteroscopic holmium laser lithotripsy for impacted ureteral stones between January 2005 and July 2013. Their stone-free state was defined as the absence of any residual stone on radiologic evaluation performed 4 weeks postoperatively. Complications were evaluated according to the modified Clavien classification. Result The mean patient age was 9.5±5.1 years (range 1–18 years). Seven (21.8%) of the stones were located in the proximal ureter, 9 (28.2%) were in the mid-ureter, and 16 (50%) were in the distal ureter. The mean stone size was calculated as being 10.46±3.8 mm2 (range 5–20). The stone-free rate was 93.75% (30/32 patients) following primary URS. Additional treatment was required for only 2 (6.25%) of the patients. After the procedure, a D-J stent was placed in all the patients. The total complication rate was 15.6% (5 patients). The 10 total complications in these 5 patients were 5 (15.6%) Grade I, 1 (3.1%) Grade II, 2 (6.25%) Grade IIIa, and 2 (6.25%) Grade IIIb. The mean follow-up period was 16.5 months (range 3–55). Conclusions For the treatment of impacted ureteral stones in children, holmium laser lithotripsy with semi-rigid ureteroscopy, with its low retreatment requirement and acceptable complication rates, is an effective and reliable method in experienced and skilled hands as a first-choice treatment approach.
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Affiliation(s)
- Senol Adanur
- Department of Urology, School of Medicine, Ataturk University, Erzurum, Turkey
| | - Hasan Riza Aydin
- Department of Urology, Akçaabat Haçkalı Baba Hospital, Trabzon, Turkey
| | - Fatih Ozkaya
- Department of Urology, School of Medicine, Ataturk University, Erzurum, Turkey
| | - Tevfik Ziypak
- Department of Urology, School of Medicine, Ataturk University, Erzurum, Turkey
| | - Ozkan Polat
- Department of Urology, School of Medicine, Ataturk University, Erzurum, Turkey
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Adanur S, Ziypak T, Yılmaz AH, Kocakgol H, Aksoy M, Yapanoglu T, Polat O, Aksoy Y. Extracorporeal shockwave lithotripsy under sedoanalgesia for treatment of kidney stones in infants: a single-center experience with 102 cases. Int Urol Nephrol 2014; 46:2095-101. [PMID: 25080207 DOI: 10.1007/s11255-014-0788-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/09/2014] [Indexed: 10/25/2022]
Abstract
OBJECT We present the efficacy of shockwave lithotripsy (SWL) therapy administered with sedoanalgesia in infants with kidney stones. MATERIALS AND METHODS We enrolled 102 patients aged 5-24 months who had kidney stones and received SWL therapy under sedoanalgesia using a Siemens Lithostar Modularis device. Patient and stone characteristics, therapy parameters, pain score, complications, discharge time, and follow-ups were registered and evaluated. Pain score was assessed using a Neonatal Infant Pain Score (NIPS). Postanesthetic discharge scoring system (PADSS) was used for the assessments of postprocedural discharge procedure. RESULTS Mean age of the patients was 17.2 ± 6.3 months (5-24 months). Mean stone size was 7.9 ± 3.3 mm (5-23 mm). The most common concomitant metabolic disorders were hypercalciuria and hypocitraturia. The stone-free rates of the infants were 70.6, 87.3, and 99.1 % after the first, second, and third sessions of SWL therapy, respectively. The mean NIPS scores procedure during, and at 1 h after SWL procedure were determined as 0.24 ± 0.45 and 0.34 ± 0.47, respectively. There was no statistically significant difference between two pain score values (P = 0.114). The mean discharge time of patients after the SWL procedure were 108.6 ± 27.9 min. Forty-two patients (41.1 %) were followed up. The follow-up period varied between 8 and 48 months (mean 19.5 months); none of those patients showed evidence of diabetes mellitus, hypertension, or renal function impairment. CONCLUSIONS SWL therapy under sedoanalgesia is a safe and efficient treatment modality that can be administered with low complication rates and high stone-free rates in the treatment of renal stones in infants.
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Affiliation(s)
- Senol Adanur
- Department of Urology, School of Medicine, Ataturk University, 25240, Erzurum, Turkey,
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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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