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Zhu H, Liu B, Karagöz MA, Yue G, Lei Y, Dou S, Xu Z, Liu Y. Reasons and risk factors for delayed discharge after day-surgery percutaneous nephrolithotomy. BMC Urol 2022; 22:209. [PMID: 36544109 PMCID: PMC9768928 DOI: 10.1186/s12894-022-01159-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Day-surgery percutaneous nephrolithotomy (PCNL) is being developed quickly but some potential factors are affecting the recovery process. This study is aim to analyze the reasons and risk factors for delayed discharge after day-surgery PCNL. METHODS The data of 205 patients who accepted day-surgery PCNL in our institution between January 2018 and February 2020 were analyzed, retrospectively. Univariate and multivariate logistic regression analysis were used to analyze the risk factors for delayed discharge. Besides, the nomogram prediction model was established by the multivariable logistic regression analysis. RESULTS The rate of delayed discharge was 14.6%. Independent risk factors for delayed discharge were larger stone burden (odds ratio [OR] = 3.814, P = 0.046), positive urine nitrite (OR = 1.001, P = 0.030), longer duration of surgery (OR = 1.020, P = 0.044), multiple nephrostomy tubes (OR = 4.282, P = 0.008). The five main reasons that caused delayed discharge included psychological reasons, pain, bleeding, urosepsis, and urine leakage. CONCLUSIONS This study identified some independent risk factors for a hospital length of stay longer than 24 h. Patients with larger renal stones or positive urine nitrite may be at increased risk of delayed discharge after day-surgery PCNL. Reducing surgery time and nephrostomy tubes will help to facilitate recovery.
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Affiliation(s)
- Huacai Zhu
- grid.490148.0Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Foshan, 528000 Guangdong China
| | - Bangfeng Liu
- grid.470124.4Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510230 Guangdong China
| | - Mehmet Ali Karagöz
- grid.16487.3c0000 0000 9216 0511Department of Urology, Faculty of Medicine, Kafkas University, 36000 Kars, Turkey
| | - Gaoyuanzhi Yue
- grid.470124.4Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510230 Guangdong China
| | - Yeci Lei
- grid.470124.4Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510230 Guangdong China
| | - Shangwen Dou
- grid.470124.4Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510230 Guangdong China
| | - Zhanping Xu
- grid.490148.0Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Foshan, 528000 Guangdong China
| | - Yongda Liu
- grid.470124.4Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510230 Guangdong China ,grid.470124.4Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou, 510230 Guangdong China
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Guideline Adherence of Paediatric Urolithiasis: An EAU Members' Survey and Expert Panel Roundtable Discussion. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040504. [PMID: 35455549 PMCID: PMC9030251 DOI: 10.3390/children9040504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 12/23/2022]
Abstract
Background: Paediatric nephrolithiasis has increased globally, requiring standardized recommendations. This study aims to assess the paediatric urolithiasis care between EAU members along with the statements of three experts in this field. Methods: The results of an electronic survey among EAU members comparing the guideline recommendations to their current practice managing paediatric nephrolithiasis in 74 centres are contrasted with insights from an expert-panel. The survey consisted of 20 questions in four main sections: demographics, instrument availability, surgical preferences and follow-up preferences. Experts were asked to give insights on the same topics. Results: A total of 74 responses were received. Computerised Tomography was predominantly used as the main imaging modality over ultrasound. Lack of gonadal protection during operations was identified as an issue. Adult instruments were used frequently instead of paediatric instruments. Stone and metabolic analysis were performed by 83% and 63% of the respondents respectively. Conclusions: Percutaneous Nephrolithotomy is the recommended standard treatment for stones > 20 mm, 12% of respondents were still performing shockwave lithotripsy despite PNL, mini and micro-PNL being available. Children have a high risk for recurrence yet stone and metabolic analysis was not performed in all patients. Expert recommendations may guide clinicians towards best practice.
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Hosseini MM, Irani D, Altofeyli A, Eslahi A, Basiratnia M, Haghpanah A, Adib A, Ahmed F. Outcome of Mini-Percutaneous Nephrolithotomy in Patients Under the Age of 18: An Experience With 112 Cases. Front Surg 2021; 8:613812. [PMID: 34211997 PMCID: PMC8239139 DOI: 10.3389/fsurg.2021.613812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 05/10/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: Renal calculi are becoming more common among children. Although, extracorporeal shock wave lithotripsy (ESWL) is the first choice in this age group, minimal invasive surgeries, such as percutaneous nephrolithotomy (PCNL), are indicated for some patients. Recently, PCNL devices have become smaller in size with acceptable efficacy and lower complications. We evaluated the outcomes and complications of mini-PCNL (MPCNL) surgery in our referral training centers. Materials and Methods: Between September 2012 and January 2020, a total of 112 children under the age of 18, who had shown failure of ESWL, and/or their parents refused to do it, underwent MPCNL (15 Fr). The patients' profiles were reviewed for data collection including preoperative and stone data, operation information, and postoperative complications. Results: Of 112 patients, 69 were boys, and 43 were girls. Their mean age was 8.6 years (14 months to 18 years). Mean stone size was 20 mm (14–34 mm). Seventy-four cases had renal pelvic stone, 22 had pelvis and lower pole, and 16 had staghorn. The mean operation time was 65 min (35–100 min), and mean radiation time was 0.6 min (0.2–1.4 min). Low-grade fever was detected in 14 patients (12.5%). Four patients needed blood transfusion and two had increased creatinine, which improved with conservative management. One patient developed urosepsis that resolved with antibiotic therapy. None of the patients had kidney perforation or other organ injury or death. Early stone-free rate (SFR) after operation was 90.2% (101 patients). Six patients had residual fragment <5 mm, which passed spontaneously in 2 weeks after operation (total SFR 95.3%). Three patients underwent second-look nephroscopy, and ureteroscopy was done for two patients due to migrated stone fragments to the distal ureter. Conclusion: MPCNL is recommended as a safe alternative option for treatment of the nephrolithiasis in children with good outcome and acceptable complications.
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Affiliation(s)
- Mohammad Mehdi Hosseini
- Shiraz Nephrology-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Dariush Irani
- Department of Urology, Shaheed Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ala'a Altofeyli
- Department of Urology, Shaheed Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Eslahi
- Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mitra Basiratnia
- Shiraz Nephrology-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolreza Haghpanah
- Department of Urology, Shaheed Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Adib
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faisal Ahmed
- Department of Urology, Urology Research Center, Al-Thora General Hospital, Ibb University of Medical Since, Ibb, Yemen
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Zeng G, Zhong W, Pearle M, Choong S, Chew B, Skolarikos A, Liatsikos E, Pal SK, Lahme S, Durutovic O, Farahat Y, Khadgi S, Desai M, Chi T, Smith D, Hoznek A, Papatsoris A, Desai J, Mazzon G, Somani B, Eisner B, Scoffone CM, Nguyen D, Ferretti S, Giusti G, Saltirov I, Maroccolo MV, Gökce MI, Straub M, Bernardo N, Lantin PL, Saulat S, Gamal W, Denstedt J, Ye Z, Sarica K. European Association of Urology Section of Urolithiasis and International Alliance of Urolithiasis Joint Consensus on Percutaneous Nephrolithotomy. Eur Urol Focus 2021; 8:588-597. [PMID: 33741299 DOI: 10.1016/j.euf.2021.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/10/2020] [Accepted: 03/02/2021] [Indexed: 02/07/2023]
Abstract
CONTEXT Although percutaneous nephrolithotomy (PCNL) has been performed for decades and has gone through many refinements, there are still concerns regarding its more widespread utilization because of the long learning curve and the potential risk of severe complications. Many technical details are not included in the guidelines because of their nature and research protocol. OBJECTIVE To achieve an expert consensus viewpoint on PCNL indications, preoperative patient preparation, surgical strategy, management and prevention of severe complications, postoperative management, and follow-up. EVIDENCE ACQUISITION An international panel of experts from the Urolithiasis Section of the European Association of Urology, International Alliance of Urolithiasis, and other urology associations was enrolled, and a prospectively conducted study, incorporating literature review, discussion on research gaps (RGs), and questionnaires and following data analysis, was performed to reach a consensus on PCNL. EVIDENCE SYNTHESIS The expert panel consisted of 36 specialists in PCNL from 20 countries all around the world. A consensus on PCNL was developed. The expert panel was not as large as expected, and the discussion on RGs did not bring in more supportive evidence in the present consensus. CONCLUSIONS Adequate preoperative preparation, especially elimination of urinary tract infection prior to PCNL, accurate puncture with guidance of fluoroscopy and/or ultrasonography or a combination, keeping a low intrarenal pressure, and shortening of operation time during PCNL are important technical requirements to ensure safety and efficiency in PCNL. PATIENT SUMMARY Percutaneous nephrolithotomy (PCNL) has been a well-established procedure for the management of upper urinary tract stones. However, according to an expert panel consensus, core technical aspects, as well as the urologist's experience, are critical to the safety and effectiveness of PCNL.
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Affiliation(s)
- Guohua Zeng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wen Zhong
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Margaret Pearle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Simon Choong
- Institute of Urology, University College Hospital, London, UK
| | - Ben Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, University of Patras, Patras, Greece
| | | | - Sven Lahme
- Department of Urology, Siloah St. Trudpert Hospital, Pforzheim, Germany
| | - Otas Durutovic
- Department of Urology, Clinic of Urology, University of Belgrade, Belgrade, Serbia
| | - Yasser Farahat
- Department of Urology, Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | - Sanjay Khadgi
- Department of Urology, Vayodha Hospital, Kathmandu, Nepal
| | - Mahesh Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Thomas Chi
- Department of Urology, University of California, San Francisco, CA, USA
| | - Daron Smith
- Institute of Urology, University College Hospital, London, UK
| | - Andras Hoznek
- Department of Urology, Mondor Hospital, Créteil, France
| | | | - Janak Desai
- Department of Urology, Samved Hospital, Ahmedabad, India
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Brian Eisner
- Deparment of Urology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Stefania Ferretti
- Department of Urology, Hospital and University of Parma, Parma, Italy
| | - Guido Giusti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | | | - Mehmet Ilker Gökce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Michael Straub
- Department of Urology, Technical University Munich, Munich, Germany
| | - Norberto Bernardo
- Department of Urology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | | | - Sherjeel Saulat
- Department of Urology, Sindh Institution of Urology and Transplantation, Karachi, Pakistan
| | - Wael Gamal
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - John Denstedt
- Division of Urology, Western University, London, Ontario, Canada
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Kemal Sarica
- Department of Urology, Biruni University, Medical School, Istanbul, Turkey.
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Cahill AM, Annam A, Baskin KM, Caplin D, Cramer HR, Connolly B, Crowley J, Heran M, Himes EA, Hogan MJ, Josephs S, Pabon-Ramos W, Prajapati H, Shivaram G, Towbin R, Vaidya SS. Society of Interventional Radiology Quality Improvement Standards for Percutaneous Nephrostomy in the Pediatric Population. J Vasc Interv Radiol 2021; 32:146-149. [PMID: 33388108 DOI: 10.1016/j.jvir.2020.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 01/25/2023] Open
Affiliation(s)
- Anne Marie Cahill
- Department of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Aparna Annam
- Department of Radiology, University of Colorado, School of Medicine, Aurora, Colorado; Interventional Radiology, Children's Hospital Colorado, Aurora, Colorado
| | - Kevin M Baskin
- Department of Interventional Radiology, Sharon Regional Medical Center, Hermitage, Pennsylvania
| | - Drew Caplin
- Division of Interventional Radiology, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Harry R Cramer
- Section of Inverventional Radiology, Coastal Vascular and Interventional, PLLC, Pensacola, Florida
| | - Bairbre Connolly
- Image Guided Therapy, Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - John Crowley
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Manraj Heran
- Pediatric Interventional Radiology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; Diagnostic and Therapeutic Neuroradiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Mark J Hogan
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Shellie Josephs
- Department of Radiology, Stanford Medicine, Palo Alto, California
| | - Waleska Pabon-Ramos
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Hasmukh Prajapati
- Division of Interventional Radiology, Department of Pediatric Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Giridhar Shivaram
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington
| | - Richard Towbin
- Department of Radiology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Sandeep S Vaidya
- Department of Interventional Radiology, University of Washington Medical Center, Seattle, Washington
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Jones P, Hawary A, Beck R, Somani BK. Role of Mini-Percutaneous Nephrolithotomy in the Management of Pediatric Stone Disease: A Systematic Review of Literature. J Endourol 2020; 35:728-735. [PMID: 33176474 DOI: 10.1089/end.2020.0743] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction: Kidney stone disease in the pediatric setting is rare, but the incidence is rising. Mini-percutaneous nephrolithotomy (mPCNL) is one of the newer surgical interventions to have been developed in recent decades. The aim of this study was to carry out a systematic review (SR) to formally evaluate the safety and efficacy of pediatric mPCNL, which was defined as PCNLs using tract size between 15F and 20F. Methods: An SR was carried out in accordance with Cochrane guidelines and A MeaSurement Tool to Assess systematic Reviews (AMSTAR) checklist. Original studies reporting on outcomes of mPCNL with 20 or more patients (aged ≤18 years) were included. Results: Eight studies were finally identified, which satisfied our predefined criteria. This included two randomized trials and six cohort studies. A total of 384 patients with a weighted mean age of 7.5 years (range: 0.5-18 years) and a male:female ratio of 3:2 underwent mPCNL. The weighted mean stone size was 1.2 cm (range: 0.8-3.5 cm). The weighted mean operative time and length of hospital stay were 76.8 minutes (range: 20-120 minutes) and 4.6 days (range: 1-33 days), respectively. The most common location(s) of stones were lower pole (57%) and renal pelvis (24.3%). The weighted mean initial and overall stone-free rates were 87.9% (range: 76%-97.5%) and 97% (range: 91.3%-100%), respectively. None of the cases required intraoperative conversion to standard PCNL. Complications occurred in 19% (n = 73) of patients. The weighted mean transfusion rate reported across studies was 3.3% (range: 0%-10.3%). Conclusions: mPCNL is safe and effective in the pediatric population. Further randomized studies will help determine its formal role in pediatric endourology and help guideline recommendations accordingly.
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Affiliation(s)
- Patrick Jones
- Department of Urology, Great Western Hospital Swindon, Swindon, United Kingdom
| | - Amr Hawary
- Department of Urology, Great Western Hospital Swindon, Swindon, United Kingdom
| | - Rupert Beck
- Department of Urology, Great Western Hospital Swindon, Swindon, United Kingdom
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton National Health Service Trust, Southampton, United Kingdom
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Imaging modalities and treatment of paediatric upper tract urolithiasis: A systematic review and update on behalf of the EAU urolithiasis guidelines panel. J Pediatr Urol 2020; 16:612-624. [PMID: 32739360 DOI: 10.1016/j.jpurol.2020.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prompt diagnosis and treatment of paediatric urolithiasis are required to avoid long term sequelae of renal damage. OBJECTIVE To systematically review the literature regarding the diagnostic imaging modalities and treatment approaches for paediatric urolithiasis. STUDY DESIGN PubMed, Science Direct, Scopus and Web of Science were systematically searched from January 1980-January 2019. 76 full-text articles were included. RESULTS Ultrasound and Kidney-Ureter-Bladder radiography are the baseline diagnostic examinations. Non-contrast Computed Tomography (CT) is the second line choice with high sensitivity (97-100%) and specificity (96-100%). Magnetic Resonance Urography accounts only for 2% of pediatric stone imaging studies. Expectant management for single, asymptomatic lower pole renal stones is an acceptable initial approach, especially in patients with non-struvite, non-cystine stones<7 mm. Limited studies exist on medical expulsive therapy as off-label treatment. Extracorporeal shock wave lithotripsy (SWL) is the first-line treatment with overall stone free rates (SFRs) of 70-90%, retreatment rates 4-50% and complication rates up to 15%. Semi-rigid ureteroscopy is effective with SFRs of 81-98%, re-treatment rates of 6.3-10% and complication rates of 1.9-23%. Flexible ureteroscopy has shown SFRs of 76-100%, retreatment rates of 0-19% and complication rates of 0-28%. SFRs after first and second-look percutaneous nephrolithotomy (PNL) are 70.1-97.3% and 84.6-97.5%, respectively with an overall complication rate of 20%. Open surgery is seldom used, while laparoscopy is effective for stones refractory to SWL and PNL. Limited data exist for robot-assisted management. CONCLUSIONS In the initial assessment of paediatric urolithiasis, US is recommended as first imaging modality, while non-contrast CT is the second option. SWL is recommended as first line treatment for renal stones <20 mm and for ureteral stones<10 mm. Ureteroscopy is a feasible alternative both for ureteral stones not amenable to SWL as well as for renal stones <20 mm (using flexible). PNL is recommended for renal stones >20 mm.
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Roth JD, Gargollo PC, DaJusta DG, Lindgren BW, Noh PH, Rensing AJ, Krambeck AE, Whittam BM. Endoscopic-assisted robotic pyelolithotomy: a viable treatment option for complex pediatric nephrolithiasis. J Pediatr Urol 2020; 16:192.e1-192.e5. [PMID: 31932240 DOI: 10.1016/j.jpurol.2019.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/12/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVE Endourological and percutaneous approaches are the standard of care for treatment of pediatric urolithiasis. However, in certain situations, an endoscopic-assisted robotic pyelolithotomy (EARP) can be an acceptable alternative. Limited data exist on pediatric EARP; thus, the authors describe their experience. METHODS Patient selection: The authors retrospectively analyzed the records of all robotic procedures performed at five institutions from 7/09-10/17 to identify patients who underwent EARP. The authors collected demographics data, indications, operative time, and postoperative complications. Stone composition was reported as the majority composition (≥50%), unless any uric acid or struvite was noted, and those stones were classified as such. TECHNIQUE Through a traditional or hidden incision endoscopic surgery (HIdES) robot pyeloplasty approach, the authors are able to easily pass a flexible endoscope through a robotic trocar and into the renal collecting system to perform pyeloscopy or ureteroscopy. Stones were primarily retrieved via the pyelolotomy and, if indicated, treated with laser lithotripsy. RESULTS The authors identified 26 patients who underwent EARP in 27 renal units. Median patient age was 12.2 years (interquartile range [IQR] 6.1-14.5 years), and body mass index was 17.5 kg/m2 (IQR 16.5-25.4 kg/m2). The median pre-operative dimension of the largest stone was 9.0 mm (IQR 5.8 mm-15.0 mm). Reasons for EARP: 21 (77.8%) concomitant pyeloplasty, four (14.8%) altered anatomy precluding other techniques, and two (7.4%) multiple large stones. Multiple stones were present in 20 renal units (74.1%). Stones were located in the renal pelvis in nine (33.3%), lower pole in 10 (37.0%), ureter in one (3.7%), and multiple locations in seven (25.9%). Hidden incision endoscopic surgery approach was used in 14 (51.9%), and the median operative time was 237.5 min (IQR 189.8-357.8 min) with a median length of stay 1.0 day (IQR 1.0-2.0 days). Stone composition included calcium oxalate in 14 (51.9%), calcium phosphate in five (18.5%), cysteine in two (7.4%), struvite in two (7.4%), and unknown in four (14.8%). Overall stone free status was 19 (70.4%); of the eight (29.6%) renal units with residual stones, four underwent ureteroscopy, two extracorporeal shockwave lithotripsy (ESWL), one spontaneously passed, and one underwent percutaneous nephrolithotomy (PCNL). After secondary treatment, final stone free rate was 96.3%. Complications included stent migration and admission for urosepsis. At a median follow-up of 12 months (IQR 6.2-19.2 months), five (18.5%) had stone recurrence. CONCLUSIONS Endoscopic-assisted robotic pyelolithotomy is a reasonable treatment option for select pediatric patients with concomitant ureteropelvic junction obstruction and nephrolithiasis or pediatric patients with stones inaccessible by standard methods.
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Affiliation(s)
- Joshua D Roth
- Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, 46202, USA.
| | | | - Daniel G DaJusta
- Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43205, USA
| | - Bruce W Lindgren
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611, USA
| | - Paul H Noh
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave #2129, Cincinnati, OH, 45229, USA
| | - Adam J Rensing
- Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, 46202, USA
| | - Amy E Krambeck
- Indiana University Health Methodist Hospital, 1801 N Senate Street, Suite 220, Indianapolis, IN, 46202, USA
| | - Benjamin M Whittam
- Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, 46202, USA
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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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