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Aydamirov M, Karkin K. Comparison of two methods for treatment of 1-2 cm kidney stones in pediatric patients: mini PCNL and RIRS. Langenbecks Arch Surg 2024; 409:207. [PMID: 38976070 DOI: 10.1007/s00423-024-03402-z] [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: 02/08/2024] [Accepted: 07/02/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE This study aimed to compare the results of retrograde intrarenal surgery (RIRS) and mini-percutaneous nephrolithotomy (mini-PCNL) for the treatment of 1-2 cm kidney stones in pediatric patients. METHODS The records of patients under the age of 18 years who were diagnosed with unilateral 1-2 cm kidney stones for the first time and underwent endoscopic surgery between February 2008 and April 2022 were retrospectively examined. The patients were divided into two groups: mini-PCNL and RIRS surgery. Parameters such as age, gender, number of stones, side, size and localization were examined. The main endpoint of the study was to compare stone-free rates (SFR) one month after both surgeries. Surgery and fluoroscopy times, postoperative hospital stay, hemoglobin decrease and complication rates were compared between the groups. SFR was evaluated one month after surgery by direct urinary system radiography and USG or CT. RESULTS A total of 58 patients were included in the study. There were 35 patients in the mini-PCNL group and 23 patients in the RIRS group. Table 1 shows the demographic and clinical characteristics of both groups. There was no significant difference between the groups in terms of age, gender, stone size, location, side and density. Calcium oxalate stones were observed at a higher rate in both groups. Mean fluoroscopy time was higher in the mini-PCNL group (p = 0.001). The mean surgery time was lower in the mini-PCNL group (p = 0.024). The mean hemoglobin decrease was greater in the percutaneous group (p = 0.039). There were no differences between the groups in terms of postoperative hospital stay, complication rates, and SFR one month after surgery. CONCLUSION Although mini-PCNL seems to be more advantageous in terms of operation time compared to RIRS, it is disadvantageous in terms of average fluoroscopy time, radiation received and average hemoglobin decrease.
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Affiliation(s)
- Mubariz Aydamirov
- Department of Urology, Baskent University, Alanya A&R Center, Antalya, Türkiye
| | - Kadir Karkin
- Department of Urology, Adana City Training and Research Hospital, Health Sciences University, Adana, Türkiye.
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2
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Yu S, Liu L, Li Y, Zhou L, Chen J, Li H, Wang K. Flexible ureteroscopic treatment of kidney stones: How do the new laser systems change our concepts? Asian J Urol 2024; 11:156-168. [PMID: 38680593 PMCID: PMC11053312 DOI: 10.1016/j.ajur.2023.11.001] [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: 01/31/2023] [Accepted: 11/24/2023] [Indexed: 05/01/2024] Open
Abstract
Objective Flexible ureteroscopy (fURS) has become a widely accepted and effective technique for treating kidney stones. With the development of new laser systems, the fURS approach has evolved significantly. This literature review aims to examine the current state of knowledge on fURS treatment of kidney stones, with a particular focus on the impact of the latest laser technologies on clinical outcomes and patient safety. Methods We conducted a search of the PubMed/PMC, Web of Science Core Collection, Scopus, Embase (Ovid), and Cochrane Databases for all randomized controlled trial articles on laser lithotripsy in September 2023 without time restriction. Results We found a total of 22 relevant pieces of literature. Holmium laser has been used for intracavitary laser lithotripsy for nearly 30 years and has become the golden standard for the treatment of urinary stones. However, the existing holmium laser cannot completely powder the stone, and the retropulsion of the stone after the laser emission and the thermal damage to the tissue have caused many problems for clinicians. The introduction of thulium fiber laser and Moses technology brings highly efficient dusting lithotripsy effect through laser innovation, limiting pulse energy and broadening pulse frequency. Conclusion While the holmium:yttrium-aluminum-garnet laser remains the primary choice for endoscopic laser lithotripsy, recent technological advancements hint at a potential new gold standard. Parameter range, retropulsion effect, laser fiber adaptability, and overall system performance demand comprehensive attention. The ablation efficacy of high-pulse-frequency devices relies on precise targeting, which may pose practical challenges.
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Affiliation(s)
- Simin Yu
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Linhu Liu
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ya Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liang Zhou
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jixiang Chen
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Sezer A, Turedi B, Guzel R, Eryildirim B, Sarica K. Comparison of Two Centers' Experience in Pediatric Supine and Prone Miniaturized Percutaneous Nephrolithotomy with Propensity Match Analysis. J Endourol 2024; 38:121-128. [PMID: 37962271 DOI: 10.1089/end.2023.0278] [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] [Indexed: 11/15/2023] Open
Abstract
Introduction: Percutaneous nephrolithotomy (PNL) is the treatment of choice in children with complex and large stones. With the experience gained from adult practice, supine PNL is increasingly performed in children as well. We aimed to evaluate the comparative results of prone and supine mini-PNL (m-PNL) performed for large/complex stones in children. Patients and Methods: The study included children who underwent supine and prone m-PNL at two centers between September 2019 and 2022. Patients were divided into two groups with a 1:1 ratio to index supine m-PNL and prone m-PNL cases for the size, number, location of the stones, degree of hydronephrosis, and age. Operative related parameters, success, and complication rates are being discussed on a procedure-based manner. Results: Forty-two patients (21 supine and 21 prone) were included. The mean age was 9.6 ± 4 years and mean stone size was 28.8 ± 13.6 mm. Regarding the operative data, the mean duration of procedure time was 65.7 ± 17.8 minutes in supine group, whereas 86.9 ± 19.0 minutes in prone group (p = 0.001). Fluoroscopy time was shorter in supine group (p = 0.027). Tubeless PNL was performed in 11 cases of prone group (52%), whereas this number was 18 (86.7%) in supine group (p = 0.019). Stone-free rates were similar in both groups (supine m-PNL: 90.5%, prone m-PNL: 85.7%, p = 0.634). Complications were minor in nature in most of the cases of both groups, which resolved with supportive measures in a short period of time. However, there was a statistically significant difference regarding the location and number accesses between two groups (p = 0.008). Simultaneous flexible ureterorenoscopy was performed in eight patients in the supine PNL group (<0.001). Conclusions: Our current findings and the highly limited data reported in the literature indicate that as an established minimal invasive treatment alternative m-PNL procedure in supine position can also be performed with similar success and complication rates in pediatric population.
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Affiliation(s)
- Ali Sezer
- Pediatric Urology Clinic, Konya City Hospital, Konya, Turkey
| | - Bilge Turedi
- Pediatric Urology Clinic, Konya City Hospital, Konya, Turkey
| | - Rasim Guzel
- Department of Urology, Medistate Hospital, Istanbul, Turkey
| | - Bilal Eryildirim
- Urology Clinic, Health Sciences University, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Kemal Sarica
- Department of Urology, Health Sciences University, Prof Ilhan Varank Training and Education Hospital, Istanbul, Turkey
- Department of Urology, Biruni University, Medical School, Istanbul, Turkey
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Tawfeek AM, Arafa H, Higazy A, Radwan A, Tawfick A. Is supine a preferred position for percutaneous nephrolithotomy in the pediatric age group? A randomized controlled study. Minerva Urol Nephrol 2024; 76:81-87. [PMID: 38426422 DOI: 10.23736/s2724-6051.23.05496-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND The aim is to evaluate supine versus prone position in mini-percutaneous nephrolithotomy in pediatric renal urolithiasis management. METHODS A randomized controlled trial was constructed to evaluate supine versus prone position in pediatric PCNL. Seventy pediatric patients with a stone burden ≥1.5 cm were randomized into two groups. RESULTS Sixty-three patients were available for evaluation in our study with no significant difference in the perioperative demographic data. The supine group showed a shorter operation time of 43.9 min compared to 73.5 min in the prone group. The stone-free rate was higher in the supine group, with a 93.9% SFR compared to 83.3% in the prone group. The supine group showed a shorter hospital stay of 2.0±1.0 days, compared to 3.20±1.56 days in the prone group. No significant difference was seen in the perioperative complication rate and fluoroscopy time between both groups. CONCLUSIONS Supine mini-percutaneous nephrolithotomy is safe and effective in managing pediatric renal stones, with a higher stone-free rate, less operative time, and less hospital stay compared to the prone position.
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Affiliation(s)
- Ahmed M Tawfeek
- Urology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hisham Arafa
- Urology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Higazy
- Urology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt -
| | - Ahmed Radwan
- Urology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Tawfick
- Urology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Adanur S, Demirdogen SO, Aksakalli T, Cinislioglu AE, Utlu A, Al S, Akkas F, Altay MS, Polat O. Outcomes of ultraminipercutaneous nephrolithotomy in infants: our experiences at a single center in an endemic region. Pediatr Surg Int 2024; 40:48. [PMID: 38300307 DOI: 10.1007/s00383-023-05623-7] [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] [Accepted: 12/26/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVE In this study, we aimed to contribute to the literature by sharing the perioperative and postoperative outcomes of infants (0-24 months) who underwent ultra-mini percutaneous nephrolithotomy (PNL) for kidney stones in our clinic. METHODS Infants under 24 months old with kidney stones of 2 cm and larger, who applied to our clinic between January 2018 and May 2023, were included in the study. The patients' demographic and clinical characteristics were obtained from the medical records. The collected data were analyzed retrospectively. RESULTS A total of 26 patients were included in the study. The mean age of the patients was 17.3 ± 3.90 (12-24) months. The mean operation time was 50.7 ± 6.43 min. The mean stone size was 2.66 ± 0.59 cm. Stone-free was achieved in 23 patients (88.5%). In one patient (3.8%) with residual fragments, SWL was performed, and in two patients (7.7%), RIRS was performed to achieve stone-free. Postoperatively, fever was observed in 3 patients (11.5%). There were no patients requiring blood transfusion. CONCLUSIONS In experienced centers, ultra-mini-PNL performed by experienced surgeons is an effective and reliable treatment option for infants under 24 months of age with kidney stones larger than 2 cm. It provides high-stone clearance rates and low complication rates.
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Affiliation(s)
| | | | - Tugay Aksakalli
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | | | - Adem Utlu
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Salih Al
- Atatürk University, Erzurum, Turkey
| | - Fatih Akkas
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
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Kumar N, Yadav P, Kaushik VN, Kakoti S, Chakraborty A, Kumar D, Ansari MS. Mini-versus standard percutaneous nephrolithotomy in pediatric population: A randomized controlled trial. J Pediatr Urol 2023; 19:688-695. [PMID: 37661501 DOI: 10.1016/j.jpurol.2023.08.013] [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: 02/19/2023] [Revised: 08/07/2023] [Accepted: 08/12/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Mini PCNL has gained popularity in adult patients due to reduction in the complication rate with comparable stone free rate. There is paucity of level 1 evidence regarding the benefit of mini PCNL in the pediatric group. OBJECTIVE We performed a randomised study to compare mini PCNL (mPCNL) with standard PCNL (sPCNL) for the management of renal calculi in patients less than 18 years of age in terms of safety, efficacy, and stone-free rate (SFR). MATERIALS AND METHODS A randomised controlled trial was performed on 50 children who underwent PCNL from June 2015 to March 2021, who were divided into two groups. Group I had 25 patients managed with mPCNL (sheath size 16.5 Fr) and Group II had 25 patients who underwent sPCNL (sheath size 26 Fr). Primary outcomes including stone free rates (SFR) and hemoglobin drop and secondary outcomes like operative time, complications, pain score, need of analgesia, incidence of nephrostomy site leak, hospital stay in days were compared between the two groups. RESULTS The mean age of patients in groups I and II was 9.4 ± 2.6 and 10.4 ± 2.26 years, respectively (p = 0.15). The mean stone sizes in both groups I and II were 18.6 ± 2.56 and 20.2 ± 3.58 mm, respectively (p > 0.05). The stone free rate for group I was 88% and for group II, 92% (p = 0.64). The average drop in hemoglobin was higher in group II compared to group I (1.1 ± 0.31 g/dl and 1.7 ± 0.23 g/dl respectively; p < 0.0001), however the mean blood transfusion rate was not significantly different in both groups. The operating time was shorter in group II compared to group I (p-value - 0.0030). The pain scores were lesser for the group I. Grade I complications were higher in group II as compared to group I (p-0.047); however, grade II complications were comparable in both groups. The mean hospital stay was not significantly different in both groups. DISCUSSION This study confirms the role of mini PCNL in pediatric patients with renal stones. The stone clearance rate of mini PCNL is equivalent to standard PCNL, with lesser blood loss and postoperative complications, however with longer operative time during mPCNL. The small number of the participants in both arms is a limitation of this study and may also reflect fewer children with urolithiasis being treated surgically even in a tertiary care referral centre. CONCLUSIONS Mini-PCNL offers equivalent stone free outcome with lower complications rate compared to the standard PCNL for all types of renal stones.
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Affiliation(s)
- Naveen Kumar
- Department of Urology, All India Institute of Medical Sciences, Patna, 801507, Bihar, India.
| | - Priyank Yadav
- Division of Pediatric Urology, Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
| | - Vinay N Kaushik
- Department of Urology, BGS Global Institute of Medical Sciences, Bangalore South, 560060 Karnataka, India.
| | - Shitangsu Kakoti
- Department of Urology, Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India.
| | - Anwesa Chakraborty
- Division of Pediatric Urology, Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
| | - Dinesh Kumar
- Division of Pediatric Urology, Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
| | - M S Ansari
- Division of Pediatric Urology, Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
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Juliebø-Jones P, Ulvik Ø, Beisland C, Somani BK. Paediatric percutaneous nephrolithotomy (P-PCNL) reporting checklist. Scand J Urol 2023; 58:115-119. [PMID: 37987596 DOI: 10.2340/sju.v58.13392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/06/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To develop a reporting checklist that serves to improve and standardise reporting in studies pertaining to paediatric percutaneous nephrolithotomy (PCNL). METHODS Based on findings from systematic review of literature, a draft list of items was formulated. By process of review and revisions, a finalised version was established and consensus achieved. RESULTS The finalised version of the checklist covers four main sections, which include the following areas: study details, pre-operative, operative and post-operative information. There are 18 further sub-items. Recommendations deemed to be of high importance to include are highlighted in bold. CONCLUSION This practical tool can aid clinicians and researchers when undertaking and reviewing studies on paediatric PCNL. This is highly relevant given the current heterogeneity that exists as well as debate in best practice patterns.
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway; EAU YAU Urolithiasis Group, Arnhem, The Netherlands.
| | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, 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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Juliebø-Jones P, Keller EX, Tzelves L, Beisland C, Somani BK, Gjengstø P, Æsøy MS, Ulvik Ø. Paediatric kidney stone surgery: state-of-the-art review. Ther Adv Urol 2023; 15:17562872231159541. [PMID: 36950219 PMCID: PMC10026105 DOI: 10.1177/17562872231159541] [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: 09/07/2022] [Accepted: 02/07/2023] [Indexed: 03/24/2023] Open
Abstract
While urolithiasis in children is rare, the global incidence is rising, and the volume of minimally invasive surgeries being performed reflects this. There have been many developments in the technology, which have supported the advancement of these interventions. However, innovation of this kind has also resulted in wide-ranging practice patterns and debate regarding how they should be best implemented. This is in addition to the extra challenges faced when treating stone disease in children where the patient population often has a higher number of comorbidities and for example, the need to avoid risk such as ionising exposure is higher. The overall result is a number of challenges and controversies surrounding many facets of paediatric stone surgery such as imaging choice, follow-up and different treatment options, for example, medical expulsive therapy, shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. This article provides an overview of the current status of paediatric stone surgery and discussion on the key topics of debate.
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Affiliation(s)
| | - Etienne Xavier Keller
- Department of Urology, University Hospital
Zurich, University of Zurich, Zurich, Switzerland EAU YAU Urolithiasis
Group, Arnhem, The Netherlands
| | - Lazaros Tzelves
- Second Department of Urology, National and
Kapodistrian University of Athens, Sismanogleio General Hospital, Athens,
Greece EAU YAU Urolithiasis Group, Arnhem, The Netherlands
| | - Christian Beisland
- Department of Urology, Haukeland University
Hospital, Bergen, NorwayDepartment of Clinical Medicine, University of
Bergen, Bergen, Norway
| | - Bhaskar K Somani
- Department of Urology, University Hospital
Southampton, Southampton, UK
| | - Peder Gjengstø
- Department of Urology, Haukeland University
Hospital, Bergen, Norway
| | | | - Øyvind Ulvik
- Haukeland University Hospital, Bergen,
NorwayDepartment of Clinical Medicine, University of Bergen, Bergen,
Norway
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9
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Slowly developing urinothorax in a child due to intrapleural migration of DJ stent-a rare complication of percutaneous nephrolithotomy. Radiol Case Rep 2022; 17:3877-3881. [PMID: 35982727 PMCID: PMC9379945 DOI: 10.1016/j.radcr.2022.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Abstract
Percutaneous nephrolithotomy is usually considered as safe and effective in the management of renal stones in pediatric population. Urinothorax defined as presence of urine in pleural cavity is a rare complication of percutaneous nephrolithotomy. We present a rare case of slowly developing urinothorax in a 9-year-old boy following PCNL due to migration of DJ stent into the pleural cavity. The case was managed by intracostal tube drainage and repositioning of DJ stent.
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10
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Brown G, Juliebø-Jones P, Keller EX, De Coninck V, Beisland C, Somani BK. Current status of nomograms and scoring systems in paediatric endourology: A systematic review of literature. J Pediatr Urol 2022; 18:572-584. [PMID: 36096999 DOI: 10.1016/j.jpurol.2022.08.021] [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: 05/01/2022] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The incidence of paediatric kidney stone disease is increasing worldwide, with the requirement for endourological interventions mirroring this. Multiple nomograms, grading tools and scoring systems now exist in the adult setting, which aim to enhance the pre-operative planning and decision-making associated with these surgeries. In recent years, there has been increasing interest in nomograms dedicated for use in the paediatric setting. This study provides an up-to-date review and assessment of available paediatric endourology nomograms and scoring systems. METHODS A comprehensive search of worldwide literature was conducted according PRISMA methodology. Studies describing paediatric-specific endourology nomograms, scoring systems or grading tools and studies externally validating these tools, or existing adult tools in a paediatric population, were evaluated and included in the narrative data synthesis. RESULTS A total of 7 endourology nomograms were identified. 4 were paediatric-specific, 2 for shockwave lithotripsy, 1 for percutaneous nephrolithotomy or ureteroscopy and 1 for percutaneous nephrolithotomy specifically. Only the 2 shockwave lithotripsy nomograms have been externally validated in 4 further studies and showed efficacy in predicting treatment success. 3 adult tools, all specific to PCNL have been investigated and validated in a paediatric setting in 11 studies. In general, they showed efficacy in the prediction of stone free rate but were poor at predicting likelihood of complications. CONCLUSION A limited number of paediatric-specific endourology predictive nomograms are available to aid in the management of kidney stone disease, with the strongest evidence supporting those designed for shockwave lithotripsy. Although 3 adult tools have been implemented, there are problems applying these to the paediatric setting and further development of paediatric-specific tools is necessary.
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Affiliation(s)
- George Brown
- Department of Urology, University Hospital Southampton, UK
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway; Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands.
| | - Etienne Xavier Keller
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands; Department of Urology, University Hospital Zurich, Switzerland
| | - Vincent De Coninck
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands; Department of Urology, AZ Klina University, Brasschaat, Belgium
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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11
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Chua ME, Kim JK, Ming JM, De Cotiis KN, Yang SS, Rickard M, Lorenzo AJ, Dos Santos J. Scoping review of recent evidence on the management of pediatric urolithiasis: summary of meta-analyses, systematic reviews and relevant randomized controlled trials. Pediatr Surg Int 2022; 38:1349-1361. [PMID: 35939126 DOI: 10.1007/s00383-022-05190-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 11/25/2022]
Abstract
This scoping review aimed to evaluate and summarize the recent 10 year pediatric urolithiasis literature with a particular focus on systematic reviews, randomized-controlled trials (RCT) and meta-analysis. The systematic literature search performed on September 1, 2021, restricted to the recent 10 years, focused on pediatric urolithiasis that are RCTs, meta-analysis and systematic reviews. The summarized literature included etiology, diagnostics, medical and surgical management. GRADE criteria are used to evaluate and standardize the reporting of evidence quality. A total of 33 relevant articles were included. The recent high-level studies included topics of genetic and diet association with pediatric stone formation, diagnostic assessment, medical management intervention including medical dissolution and expulsion therapy. The study extended to include the efficacy and safety of extracorporeal lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery. However, evidence quality was ranked "very-low" or "low". Based on the GRADE criteria downgrading of the quality level was due to heterogeneity and low precision. A majority of the RCTs were categorized as having a "high" to "uncertain" risk of bias. The relevant RCTs, meta-analyses and systematic reviews within the past decade are of low quality. Consequently, the research provided no clear evidence-based recommendations for managing pediatric urolithiasis. More rigorous research and high-quality studies are needed to determine the best practices.
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Affiliation(s)
- Michael E Chua
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines.
| | - Jin Kyu Kim
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jessica M Ming
- Department of Urology, University of New Mexico, Albuquerque, NM, USA
| | - Keara N De Cotiis
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Stephen S Yang
- Division of Urology, Buddhist Tzu Chi General Hospital, New Taipei Branch, New Taipei City, Taiwan
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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12
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Comparison between prone and supine nephrolithotomy in pediatric population: a double center experience. Int Urol Nephrol 2022; 54:3063-3068. [PMID: 35962906 DOI: 10.1007/s11255-022-03341-y] [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: 05/13/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Stone disease in the pediatric age is an increasing issue. Percutaneous Nephrolithotomy (PNL) can be used for larger and complex stones. As in adults it can be performed in the supine or prone position. METHODS We retrospectively reviewed two centers' experience in prone and supine PNL in children to analyze its results and complications. RESULTS 33 patients underwent prone and 19 supine procedures. Patients in the prone group were younger than in the supine, while no significant differences were found in stone burden, access size, operative time or complications. Complications were: 8 and 4 Clavien 1 for the prone and supine group, respectively, one case of urosepsis (4b) in the prone and 2 cases of Clavien 3 in the supine group (double J stent placement for renal colic and ureteroscopy for steinstrasse). Tubeless procedures and mean nephrostomy time were in favor of the supine group, whereas fluoroscopy time and ureteral drainage stay were in support of the prone group. Stone free rate was better in the supine group (83.3 vs 66.6%), possibly reflecting the capability to perform a combined approach in 12 patients (allowing to reach all the calyx with simultaneous anterograde and retrograde access) or younger age in the prone group (13 vs 2 patients ≤5 years), with no differences in stone burden. CONCLUSIONS Supine approach seems to guarantee higher stone-free rates. Larger series are necessary to determine what the best technique is in terms of X-ray exposure, operative time and complications.
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Gui H, Wang H, Kaushik D, Rodriguez R, Wang Z. Mini-Percutaneous Nephrolithotomy With an Endoscopic Surgical Monitoring System for the Management of Renal Stones: A Retrospective Evaluation. Front Surg 2022; 9:773270. [PMID: 35898587 PMCID: PMC9309435 DOI: 10.3389/fsurg.2022.773270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTo compare the outcomes and postoperative quality of life of patients with renal calculi who underwent standard percutaneous nephrolithotomy (sPNL), mini-invasive percutaneous nephrolithotomy (mPNL) or mPNL with an endoscopic surgical monitoring system (ESMS) using a retrospective clinical trial.MethodsEighty-six adult patients with renal stones who were treated with sPNL were retrospectively compared to ninety-two patients who were treated with mPNL between July 2014 and December 2017. Next, further studies were retrospectively conducted using a matched paired method. The ninety-two patients treated with mPNL were divided into two groups based on whether the endoscopic surgical monitoring system (ESMS) was used (ESMS-mPNL vs. non-ESMS-mPNL). The ESMS used strain gauge transducers to measure the inflow and outflow of irrigation solution. Bleeding and fluid absorption during endoscopic surgery could be accurately calculated by computer program in ESMS.ResultsThe fluoroscopy time, complication rate, stone-free status and clinically insignificant residual fragment (CIRF) rate were not significantly different between the two groups (sPNL vs. mPNL). The mPNL group had a significantly longer operation time than the sPNL group, and the mPNL group exhibited a markedly reduced 12-h postoperative visual analogue pain scale (VAS) score, mean hospitalization time, and return to work time, had slightly reduced haemoglobin loss, and underwent more tubeless operations. Moreover, among the 92 patients who underwent mPNL, the operation time (P = 0.090), complication rate (P = 0.996), stone-free status (P = 0.731), CIRF rates (P = 0.125) and number of tubeless operations (P = 0.760) were not significantly different between the two subgroups (non-ESMS-mPNL vs. ESMS-mPNL); however, the patients in the ESMS-mPNL group had significantly longer irrigation times than those in the non-ESMS-mPNL subgroup, along with marked reductions in irrigation fluid, blood loss, haemoglobin loss, 12 h postoperative VAS score, mean hospitalization time, and return to work time.ConclusionsmPNL is less painful than sPNL in patients undergoing treatment for 20–40 mm renal stones. Similar stone-free rates were achieved by the two procedures, but mPNL was superior to sPNL in terms of blood loss, discomfort, hospitalization time and return to work time. We think that ESMS-mPNL is less painful for patients and more efficacious than non-ESMS-mPNL, and ESMS-mPNL achieves a stone-free rate that is similar to non-ESMS-mPNL in patients receiving treatment for 20–40 mm kidney stones.
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Affiliation(s)
- Huiming Gui
- Department of Urology, Institute of Urology, Gansu Nephro-Urological Clinical Center, Key Laboratory of Urological Diseases in Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Hanzhang Wang
- Department of Urology, Institute of Urology, Gansu Nephro-Urological Clinical Center, Key Laboratory of Urological Diseases in Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Dharam Kaushik
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TXUnited States
| | - Ronald Rodriguez
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TXUnited States
| | - Zhiping Wang
- Department of Urology, Institute of Urology, Gansu Nephro-Urological Clinical Center, Key Laboratory of Urological Diseases in Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
- Correspondence: Zhiping Wang
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Abstract
PURPOSE OF REVIEW The aim of this study was to discuss current trends and recent developments in the surgical management of paediatric urolithiasis. RECENT FINDINGS Medical expulsive therapy (MET) is considered as an option for the treatment of children with ureter stones. Extracorporeal shockwave lithotripsy (SWL) remains as a first option for majority of kidney stones and upper ureter stones. Advances in endourology have led to increased adoption of retrograde intrarenal surgeries (RIRS) and percutaneous nephrolithotomy (PCNL/mini-PCNL/ultra-mini-PCNL/micro-PCNL). SUMMARY Management of paediatric stone disease has developed significantly in the past decade. However, the evidence in the literature remains disproportional to these advances. Well designed multicentric studies are still needed to compare effectiveness and safety of these procedures.
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Zeid M, Sayedin H, Alsaid A, Sridharan N, Narayanaswa A, Giri S, Abul F, Almousawi S. Outcomes of Mini-Percutaneous Nephrolithotomy in Children and Adolescents: A 10-Year Single-Centre Experience From Kuwait. Cureus 2022; 14:e25022. [PMID: 35712329 PMCID: PMC9197546 DOI: 10.7759/cureus.25022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2022] [Indexed: 11/24/2022] Open
Abstract
The current study retrospectively reviewed data for all children and adolescents who underwent mini-percutaneous nephrolithotomy (PCNL) at Ibn Sina Hospital and Sabah Al Ahmad Urology Centre in Kuwait over 10 years. Accordingly, the 40 patients underwent mini-PCNL. Among them, 21 patients (52.5%) had varying degrees of hydronephrosis, with mild to moderate severity accounting for nearly half of them, whereas six (15%) had multiple stones. The median operative time was 54.5 (43.3-64) minutes. Moreover, 11 patients needed flexible ureteroscopy (URS) and double-J (DJ) ureteric stent, and one patient required DJ ureteric stent only. None of the cases developed intraoperative bleeding. The median hospital stay of the included patients was three (2.3-4) days. Residual stone was observed in 11 patients (27.5%), with a median size of 3 (2 to 7) mm. The incidence of postoperative complications was 27.5% (n = 11 patients), with three patients experiencing postoperative bleeding (7.5%) and eight patients developing a fever (20%). All patients had mild postoperative pain. However, no leakage, sepsis, or pelvic injury occurred. None of the patients required revision. In conclusion, mini-PCNL was a safe and effective procedure in children and adolescents with renal stones.
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Is Mini Percutaneous Nephrolithotomy a Game Changer for the Treatment of Renal Stones in Children? EUR UROL SUPPL 2022; 37:45-49. [PMID: 35243389 PMCID: PMC8883193 DOI: 10.1016/j.euros.2021.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 12/01/2022] Open
Abstract
Background Mini percutaneous nephrolithotomy (MPCNL) is a newer surgical procedure that has changed the management of paediatric renal stones. Objective To evaluate MPCNL morbidity and success rates for renal stones as a function of patient age in a paediatric cohort. Design, setting, and participants This was a retrospective case series that included 143 consecutive patients younger than 17 yr who underwent MPCNL at our institution between January 2016 and November 2020. The patients were categorised into three different age groups: <6 yr (n = 71, 49.7%), 6–11 yr (n = 44, 30.8%), and 12–17 yr (n = 28, 19.6%). MPCNL was performed in all patients through 16–20Fr tracts. Outcome measurements and statistical analysis The stone-free rate, perioperative complications, tract number, operative time, postoperative haemoglobin change, and hospitalisation time were evaluated for each age group. Results and limitations MPCNL was performed in 143 paediatric patients (88 boys and 55 girls; mean age 6.53 yr). The mean stone burden (± standard deviation) was 2.096 ± 1.01 cm in group one, 2.05 ± 1.05 cm in group two, and 3.46 ± 19.94 cm in group three; group three was significantly larger (p = 0.001). After a single MPCNL session, 92.42% of patients experienced complete stone clearance. All age groups were similar in terms of stone-free rate (p = 0.82), hospitalisation time (p = 0.94), postoperative haemoglobin change (p = 0.06), and perioperative complications (p = 0.62). However, stone size (p = 0.009), stone complexity (p = 0.001), number of access points (p = 0.03), and operative time (p = 0.009) were higher in the group aged 12–17 yr. Conclusions MPCNL is an effective and safe procedure in younger as well as older children. Age should not be considered a limiting factor for MPCNL in children, and MPCNL should be considered the primary option for treating paediatric renal stones when PCNL is indicated. Patient summary Our results show that surgical removal of kidney stones through an incision in the skin and using miniaturised instruments is an effective and safe procedure for children.
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Peng T, Zhong H, Hu B, Zhao S. Minimally invasive surgery for pediatric renal and ureteric stones: A therapeutic update. Front Pediatr 2022; 10:902573. [PMID: 36061394 PMCID: PMC9433542 DOI: 10.3389/fped.2022.902573] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022] Open
Abstract
The incidence of pediatric urolithiasis (PU) is growing worldwide. The corresponding therapeutic methods have become a research hot spot in pediatric urology. PU has the characteristics of abnormal metabolism, easy recurrence, and immature urinary system development, which make its treatment different from that of adults. Pediatric urologists should select the optimal treatment modality to completely remove the stones to prevent recurrence. Currently, the curative treatments of PU include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, retrograde intrarenal surgery, percutaneous nephrolithotomy (PCNL), laparoscopic, robot-assisted laparoscopic, and open surgery. This review aims to conduct a therapeutic update on the surgical interventions of both pediatric renal and ureteric stones. It accentuates that pediatric surgeons or urologists should bear in mind the pros and cons of various minimally invasive surgical treatments under different conditions. In the future, the treatment of PU will be more refined due to the advancement of technology and the development of surgical instruments. However, a comprehensive understanding of the affected factors should be taken into account by pediatric urologists to select the most beneficial treatment plan for individual children to achieve precise treatment.
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Affiliation(s)
- Tao Peng
- Department of Pediatric Surgery, Huizhou Central People's Hospital, Huizhou, China
| | - Hongcai Zhong
- Department of Pediatric Surgery, Huizhou Central People's Hospital, Huizhou, China
| | - Baohui Hu
- Department of Pediatric Surgery, Huizhou Central People's Hospital, Huizhou, China
| | - Shankun Zhao
- Department of Urology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
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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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