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Elbakary M, Alruwaili S. Utilization of Flexible Ureteroscopy in Renal Stones Management in Pediatrics: Single Tertiary Center Experience. Glob Pediatr Health 2023; 10:2333794X231199637. [PMID: 37809363 PMCID: PMC10559721 DOI: 10.1177/2333794x231199637] [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] [Received: 07/10/2023] [Revised: 08/12/2023] [Accepted: 08/21/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives. To assess the effectiveness and safety of flexible ureteroscopy in children treated at our center during the last 5 years. Methods. Retrospectively, we have studied 41 children that suffered 51 stone episodes, and FURS for renal calculi <2 cm. Preoperative, operative, and postoperative data were gathered. Results. The mean age of the 41 kids who experienced 51 stone episodes was 9.6 [2.8] years (4.2-16 years). The mean stone diameter was 12.8 [3.3] mm (6-20 mm). The mean operative time was 79.9 [19.9] minutes. The mean hospital stay was 27.6 [12.9] hours. The SFR after the first session was 64.7% and 80.4% after the second session. The overall complications had been recorded in 25 cases (49%) with low morbidity (Clavien grade I-III). Conclusions. Pediatric FURS is a minimally invasive option with a high SFR and a low percentage of high-grade complications in the management of pediatric renal stones.
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Affiliation(s)
- Mohamed Elbakary
- King Fahd Specialized Hospital, Tabuk, Saudi Arabia
- Tanta University Hospital, Tanta, Egypt
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Smeulders N, Cho A, Alshaiban A, Read K, Fagan A, Easty M, Minhas K, Barnacle A, Hayes W, Bockenhauer D. Shockwaves and the Rolling Stones: An Overview of Pediatric Stone Disease. Kidney Int Rep 2022; 8:215-228. [PMID: 36815103 PMCID: PMC9939363 DOI: 10.1016/j.ekir.2022.11.017] [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] [Received: 09/14/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
Urinary stone disease is a common problem in adults, with an estimated 10% to 20% lifetime risk of developing a stone and an annual incidence of almost 1%. In contrast, in children, even though the incidence appears to be increasing, urinary tract stones are a rare problem, with an estimated incidence of approximately 5 to 36 per 100,000 children. Consequently, typical complications of rare diseases, such as delayed diagnosis, lack of awareness, and specialist knowledge, as well as difficulties accessing specific treatments also affect children with stone disease. Indeed, because stone disease is such a common problem in adults, frequently, it is adult practitioners who will first be asked to manage affected children. Yet, there are unique aspects to pediatric urolithiasis such that treatment practices common in adults cannot necessarily be transferred to children. Here, we review the epidemiology, etiology, presentation, investigation, and management of pediatric stone disease; we highlight those aspects that separate its management from that in adults and make a case for a specialized, multidisciplinary approach to pediatric stone disease.
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Affiliation(s)
- Naima Smeulders
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Alexander Cho
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Abdulelah Alshaiban
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK,Department of Pediatrics, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Katharine Read
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Aisling Fagan
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Marina Easty
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Kishore Minhas
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Alex Barnacle
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Wesley Hayes
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Detlef Bockenhauer
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK,Department of Renal Medicine, University College London, London, UK,Correspondence: Detlef Bockenhauer, Department of Renal Medicine, University College London, London, UK.
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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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Nerli RB, Sharma M, Gupta P, Adhikari P, Bidi S, Ghagane SC. Therapeutic ureteroscopy for urolithiasis in children younger than 60 months of age. Pediatr Surg Int 2021; 37:145-150. [PMID: 33170363 DOI: 10.1007/s00383-020-04777-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The management of urinary tract calculi has evolved dramatically in children with the development of smaller and more durable endoscopic equipment. The indications for therapeutic ureteroscopy in children have significantly expanded with the availability of smaller caliber endoscopes and Holmium:YAG laser. In this paper, we review our experience of the management of urolithiasis and report outcomes of therapeutic ureterorenoscopy (URS) in children younger than 60 months. METHODS We retrospectively reviewed the inpatient, outpatient records, and imaging data of our hospital, of all children ≤ 60 months of age undergoing URS for the treatment of urinary stones. RESULTS During the study period; 77 children, mostly male (70.1%) presenting with a single calculus and a mean age of 28.97 ± 2.44 months underwent therapeutic URS. A majority of children (71.4%) had lower or mid-ureteric calculi. Pre URS double J (DJ) stenting was necessary for 21 (27.2%) children. A total of 24 (31.1%) children needed ureteric dilatation before the ureteroscopy. Post URS DJ stenting was necessary in 41 (53.2%) children. Stents were retrieved within 10 days of the procedure. Stone clearance rate following a single-stage URS procedure was 94.8%, and 4 (5.2%) children needed additional shockwave lithotripsy (SWL) to achieve stone clearance. Overall complication rate including hematuria and fever was 12.9% (10 patients). CONCLUSION Therapeutic ureterorenoscopy in the management of ureteric and selective renal pelvic calculi is safe and effective. It can be considered as the first-line therapy in young children.
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Affiliation(s)
- Rajendra B Nerli
- Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), JNMC Campus, Nehru Nagar, Belagavi, 590010, Karnataka, India.
| | - Manas Sharma
- Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), JNMC Campus, Nehru Nagar, Belagavi, 590010, Karnataka, India
| | - Pulkit Gupta
- Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), JNMC Campus, Nehru Nagar, Belagavi, 590010, Karnataka, India
| | - Priyabrata Adhikari
- Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), JNMC Campus, Nehru Nagar, Belagavi, 590010, Karnataka, India
| | - Saziya Bidi
- Department of Urology, Urinary Biomarker Research Centre, KLES Kidney Foundation, KLES Dr, Prabhakar Kore Hospital & Medical Research Centre, Nehru Nagar, Belagavi, 590010, Karnataka, India
| | - Shridhar C Ghagane
- Department of Urology, Urinary Biomarker Research Centre, KLES Kidney Foundation, KLES Dr, Prabhakar Kore Hospital & Medical Research Centre, Nehru Nagar, Belagavi, 590010, Karnataka, India
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Technique, complications, and outcomes of pediatric urolithiasis management at a tertiary care hospital: evolving paradigms over the last 15 years. J Pediatr Urol 2019; 15:665.e1-665.e7. [PMID: 31648889 DOI: 10.1016/j.jpurol.2019.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 09/10/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite technological advancements, there is lack of consensus for the standard treatment modalities for pediatric urolithiasis. OBJECTIVE The primary objective was to review the management of pediatric urolithiasis over the last 15 years in terms of technical modifications, surgical outcomes, and complications. The secondary objective was to compare the efficacy and outcomes of standard percutaneous nephrolithotomy (PCNL) and mini-PCNL for renal and upper ureteric calculi. STUDY DESIGN Medical records of all patients aged <18 years who presented to the authors' tertiary care hospital in northern India between August 2003 and December 2018 were reviewed retrospectively. Before 2010, all PCNLs performed were standard PCNL, whereas after 2010, most PCNLs performed were mini-PCNL. Thus, the patients were divided into two groups: group A (patients up to 2010) and group B (patients after 2010). These were compared for the type of treatment, success rate, and complications. The outcomes of surgical management of lower ureteric and vesical calculi were also reviewed. RESULTS During this period, there were 580 children with urolithiasis (677 stone sites). There were 265 patients (321 stone sites) in group A and 315 patients (356 stone sites) in group B. The median age was seven years (range: 3-18 years). The most common location of calculus was the collecting system of the kidney (n = 398, 58.8%). A total of 175 stone sites (25.8%) were located in the ureter. Urinary bladder calculi were seen in 43 (6.4%) patients. Multiple stones were seen in 61 sites (9.0%). A total of 115 patients in group A underwent standard PCNL, whereas in group B, nine patients underwent standard PCNL and 129 underwent mini-PCNL. Group B had a significantly higher stone clearance rate for mini-PCNL (P < 0.001). Minor complications (grades 1 and 2) accounted for a majority of overall complications in both groups (87.5% in group A and 94.9% in group B). DISCUSSION Mini-PCNL is an excellent option for renal calculi in children as it offers dual advantages of improved stone clearance and reduced major complications such as bleeding. Ureteroscopic lithotripsy has been established as the standard for small lower ureteric calculi. CONCLUSION For renal and upper ureteric calculi, mini-PCNL has evolved as standard technique with a high stone-free rate and minimum complications compared with standard PCNL. Extracorporeal shockwave lithotripsy and ureteroscopic lithotripsy (URSL)/retrograde intrarenal surgery are acceptable alternatives for smaller stone burden. For lower ureteric and vesical calculi, retrograde approaches such as cystolithotripsy and URSL have now become the standard of care.
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Ellison JS, Yonekawa K. Recent Advances in the Evaluation, Medical, and Surgical Management of Pediatric Nephrolithiasis. CURRENT PEDIATRICS REPORTS 2018. [DOI: 10.1007/s40124-018-0176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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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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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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Li J, Xiao J, Han T, Tian Y, Wang W, Du Y. Flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants. Exp Biol Med (Maywood) 2016; 242:153-159. [PMID: 27633576 DOI: 10.1177/1535370216669836] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We evaluated the clinical value of flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants. Fifty-five infants with upper urinary tract calculi were included in this study: 41 males and 14 females. Retrograde intrarenal surgery was performed by an 8 Fr/30 cm flexible ureterorenoscope (POLY®) combined with a holmium laser. CT scanning or radiography of the kidneys, ureters, and bladder region was performed one month after the operation to confirm the clearance of calculi. All the 55 infants with calculi in 74 sides underwent 66 flexible ureteroscopic lithotripsy procedures. The median operation time was 30 min. The median amount of flushing fluid was 500 mL. The stone-free rate after a single session treatment was 94.6%, within which 10 infants underwent simultaneous bilateral flexible ureteroscopy lithotripsy. Catheters were retained in 45 infants for 24-48 h after the operation. Continuous high fever due to reflux was present in two cases. Flushing fluid extravasation was found in one infant. Some patients with minor complications, such as mild hematuria, irritation symptoms, and low fever, recovered without treatment. The duration of hospitalization time after the operation was approximately 1-5 days. Flexible ureteroscopic lithotripsy is a safe, highly efficient, minimally invasive, and reproducible operation for removal of upper urinary tract calculi in infants. This technique is a convenient method for postoperative management of patients that enhances their rapid recovery. It is a promising option for therapy of infants ineffectively treated by extracorporeal shockwave lithotripsy.
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Affiliation(s)
- Jun Li
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jing Xiao
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Tiandong Han
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Wenying Wang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yuan Du
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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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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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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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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Long CJ, Srinivasan AK. Percutaneous nephrolithotomy and ureteroscopy in children: evolutions. Urol Clin North Am 2014; 42:1-17. [PMID: 25455168 DOI: 10.1016/j.ucl.2014.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The increasing incidence of pediatric stone disease has coincided with significant advances in technology and equipment, resulting in drastic improvements in management. Miniaturization of both ureteroscopes and percutaneous nephrolithotomy (PCNL) equipment has facilitated access to the entirety of the urinary tract and has made ureteroscopy a first-line therapy option along with shock-wave lithotripsy for kidney and ureteral stones. Advances in PCNL have decreased patient morbidity while preserving stone clearance rates. In this review, the advances in operative approach for ureteroscopy and PCNL in children and its applicability to current surgical management of pediatric stone disease are discussed.
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Affiliation(s)
- Christopher J Long
- Division of Urology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3rd Floor, Wood Center, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Arun K Srinivasan
- Division of Urology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3rd Floor, Wood Center, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Li C, Chen J, Zhang J, Zou Q, Chen J, Min Z. Management of biliary and pancreatic diseases using a new intraductal endoscope. J Laparoendosc Adv Surg Tech A 2014; 24:130-3. [PMID: 24443952 DOI: 10.1089/lap.2013.0348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We aimed to evaluate a new single-operator mini-endoscope for its performance, feasibility, and safety in the management of biliary and pancreatic diseases. PATIENTS AND METHODS A retrospective analysis was conducted of 47 patients (19 men; mean age, 50.3 years) who underwent cholangioscopy with the Polydiagnost (Pfaffenhofen, Germany) Polyscope device via various approaches for diagnosis and treatment of biliary and pancreatic diseases between January 2011 and July 2012. RESULTS Biliary pancreatic duct endoscopy was performed through a cystic duct, common bile duct, peroral, or sinus tract approach in 21, 9, 11, and 6 patients, respectively. Thirty-two cases with bile duct stones were treated by basket extraction or complete stone fragmentation, 3 cases with tumor were treated by tissue ablation, and 4 cases with stricture were treated by stenting. Seven patients who were diagnosed with suspected stones preoperatively were excluded. No complications and morbidity associated with the use of biliary and pancreatic endoscopy was observed in this study. CONCLUSIONS Cholangioscopy using the Polyscope system is a safe and effective technique for diagnosing or excluding biliary and pancreatic diseases (stone, strictures, or tumor).
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Affiliation(s)
- Chunsheng Li
- 1 Department of General Surgery, Pudong Hospital , Shanghai, China
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Salerno A, Nappo SG, Matarazzo E, De Dominicis M, Caione P. Treatment of pediatric renal stones in a Western country: a changing pattern. J Pediatr Surg 2013; 48:835-9. [PMID: 23583143 DOI: 10.1016/j.jpedsurg.2012.09.058] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 08/03/2012] [Accepted: 09/10/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Over the last 10years the miniaturization of endoscopic instruments made minimally invasive procedures for kidney stones feasible even in children. The evolution in management of kidney stones in a tertiary care center in Europe is reported. METHODS Patients treated in our hospital for kidney stones from 2002 to 2011 were reviewed and group A (2002 to 2006) was compared with group B (2007 to 2011). The therapeutic options offered were Extracorporeal Shock Waves Lithotripsy (ESWL), Retrograde Intrarenal Surgery (RIRS), Percutaneous Lithotripsy (PCNL) and open surgery. Outcome measures were: first treatment chosen, stone free rate after a single procedure, and retreatment. Results were compared by chi-square test, with p <0.05 considered statistically significant. RESULTS 333 patients, mean age 9.7years, were treated, 161 in group A and 172 in group B. ESWL was the first option in both groups, but decreased by 34% in group B vs A. In contrast, RIRS and PCNL increased by 17% and 16%, respectively, in group B vs group A. Open surgery was never required in primary lithiasis cases without associated malformations. CONCLUSION The advent of PCNL and RIRS has significantly changed the pattern of renal stone treatment in the pediatric age group. A progressive increase of endourologic minimally invasive procedures was recorded. Open surgery should be a very rare option.
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Affiliation(s)
- Annamaria Salerno
- Division of Pediatric Urology, Department Nephrology and Urology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Netsch C, Knipper S, Bach T, Herrmann TRW, Gross AJ. Impact of preoperative ureteral stenting on stone-free rates of ureteroscopy for nephroureterolithiasis: a matched-paired analysis of 286 patients. Urology 2012; 80:1214-9. [PMID: 23084830 DOI: 10.1016/j.urology.2012.06.064] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/22/2012] [Accepted: 06/18/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the effect of preoperative ureteral stenting on success rates of ureteroscopy (URS) for nephroureterolithiasis. MATERIALS AND METHODS We retrospectively evaluated patients who underwent URS for nephroureterolithiasis without preoperative indwelling ureteral stents. These patients were matched according to age, sex, body mass index, and stone side, size, site, and number of stones per patient, with patients who had been prestented before URS. Patient data, stone-free rates (SFRs), and complications were compared. RESULTS The study included 286 patients (143 stented vs 143 nonstented). The mean stone size was 5.69 ± 3 mm. The mean number of stones per patient was 1.35 ± 0.7. The overall SFR after 1 URS procedure was 90.9% and higher in prestented than in nonstented patients (95.1% vs 86.7%, P ≤ .013). For ureteral stones, the SFR was 99% in prestented and 90% in nonstented patients (P ≤ .0048). The SFR did not differ between the groups for ureteral stones <5 mm, but was higher in prestented than in nonstented patients for ureteral calculi ≥ 5 mm (98.2% vs 83.3%, P ≤ .0105). For urinary calculi ≥ 5 mm, the overall SFR was higher in prestented than in nonstented patients (93.3 vs 78.3%, P ≤ .0054). Perioperative complications occurred in 27 patients (9.4%; Clavien I, 6.6%; Clavien IIIb, 2.8%) without differences between the groups. CONCLUSION URS is a safe and efficacious procedure for the treatment of nephroureterolithiasis. Preoperative ureteral stent placement is associated with higher SFRs compared with nonstented patients for urinary calculi ≥ 5 mm. Nonstented patients with urinary calculi ≥ 5 mm should be informed about the risk for a second-look URS procedure.
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Jayakumar S, Marjan M, Wong K, Bolia A, Ninan GK. Retrieval of proximally migrated double J ureteric stents in children using goose neck snare. J Indian Assoc Pediatr Surg 2012; 17:6-8. [PMID: 22279356 PMCID: PMC3263043 DOI: 10.4103/0971-9261.91078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Proximal migration of the ureteric double J stent is a rare but known complication. We describe three cases where a minimally invasive technique for retrieval of displaced double J stents using Amplatz™ goose-neck snare was successful. Materials and Methods: A retrospective review of patients with displaced double J stent was carried out, in whom cystoscopy guided retrieval of double J stent was attempted with the help of Amplatz goose-neck snare under radiological control. Results: All three patients were under the age of 3 years. Two patients had migrated double J stent following pyeloplasty and in one patient the double J stent was displaced during a retrograde insertion of double J stent. In all cases, retrieval of displaced double J stent was successfully achieved using Amplatz goose-neck snare. There were no postoperative complications. Conclusion: Our method of retrieval of stent from renal pelvis is simple, safe and minimally invasive. This technique is a useful and safe alternative option for retrieval of proximally migrated double J stents in children.
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Affiliation(s)
- Sivasankar Jayakumar
- Department of Paediatric Urology, Leicester Royal Infirmary, University Hospitals Leicester, Leicester, LE1 5WW, United Kingdom
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Abstract
The surgical armamentarium of the pediatric urologist has changed greatly in the past 2 decades on account of new technology and careful adaptation of minimally invasive techniques in children. Conventional laparoscopy, robotic-assisted laparoscopy, laparoendoscopic single-site surgery, and endourologic surgery have, to varying degrees, provided new approaches to urologic surgery in the pediatric population. This article reviews the technology and adaptations behind these recent advances as well as their current applications in management of urologic disease in children.
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Affiliation(s)
- Robert M Turner
- Division of Pediatric Urology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Patient Evaluation and Comparison of Stone-Removing Strategies in Pediatric Patients with Urinary Tract Stones. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gross AJ, Netsch C. Retrograde Intrarenal Surgery (RIRS). Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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