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Bitkin A, Özlü DN, Ekşi M, Kargı T, Fakir AE, Ayten A, Polat H, Taşçı Aİ. A comparative analysis of the efficacy and safety of mini-percutaneous nephrolithotomy performed in the supine and prone positions for the treatment of pediatric kidney stones: a single-center experience. Urolithiasis 2023; 51:122. [PMID: 37847257 DOI: 10.1007/s00240-023-01497-5] [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: 09/04/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023]
Abstract
Mini-percutaneous nephrolithotomy (MPCNL), which has a smaller tract size (14-20 Fr) than conventional percutaneous nephrolithotomy, has been shown to be safe and effective in pediatric patients with large and complex upper urinary tract stones. This study aimed to compare the efficacy and safety of MPCNL between the supine and prone positions in a pediatric population. The data of pediatric patients who underwent MPCNL at our center between January 2010 and March 2023 were retrospectively analyzed. According to the surgical position, the patients were divided into the prone (Group P) and supine (Group S) groups. In both groups, dilatation was performed using 14-18 Fr metallic dilators. The two groups were compared in terms of perioperative data, postoperative stone-free rates (SFRs), and complications. There were 36 (59%) patients in Group P and 25 (41%) patients in Group S. Stones were mostly located in the pelvis (49.2%) and second most frequently in the lower pole (27.9%). Fluoroscopy time was shorter in Group S but did not statistically significantly differ compared to Group P (p = 0.181). However, operation time was statistically significantly shorter in Group S (73.8 ± 35 vs. 99.8 ± 37.4 min, p = 0.008). Although there was no significant difference, relatively higher SFR were detected in Group S (88% vs. 83%, p = 0.725). Endoscopic combined intrarenal surgery (ECIRS) was performed on six (24%) patients in Group S, and the SFR was 100% among these patients. There was no significant difference between the two groups in terms of the presence of complications (16.7% vs. 16%, p = 0.945). Both supine and prone MPCNL appear to be safe and effective in the pediatric age group, with similar stone-free and complication rates. In the supine procedure, the operation time is shortened compared to the prone. In addition, simultaneous retrograde access has the potential to increase the overall success rate of surgery.
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Affiliation(s)
- Alper Bitkin
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey.
| | - Deniz Noyan Özlü
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
| | - Mithat Ekşi
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
| | - Taner Kargı
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
| | - Ali Emre Fakir
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
| | - Ali Ayten
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
| | - Hakan Polat
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
| | - Ali İhsan Taşçı
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
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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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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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