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Juliebø‐Jones P, Gauhar V, Lim EJ, Traxer O, Madarriaga YQ, Castellani D, Fong KY, Bujons A, Ragoori D, Shrestha A, Vaddi CM, Bhatia TP, Sekerci CA, Tanidir Y, Teoh JY, Somani BK. Outcomes and considerations for retrograde intrarenal surgery (RIRS) in the setting of multiple and large renal stones (>15 mm) in children: Findings from multicentre and real-world setting. BJUI COMPASS 2024; 5:558-563. [PMID: 38873356 PMCID: PMC11168767 DOI: 10.1002/bco2.357] [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: 01/30/2024] [Revised: 02/24/2024] [Accepted: 03/10/2024] [Indexed: 06/15/2024] Open
Abstract
Purpose The aim of this study is to evaluate the outcomes of retrograde intra renal surgery (RIRS) in the setting of large or multiple stones in children (<18 years). Materials and Methods Retrospective analysis was performed of paediatric RIRS cases at nine centres worldwide over a 6-year period. Patients were divided into two groups: Group 1 had a single stone <15 mm. Group 2 had either multiple stones, maximum stone diameter of >15 mm, or both. Outcomes included stone free rate (SFR) and complications within 30 days. Results In total, 344 patients were included with 197 and 147 in Groups 1 and 2, respectively. Ureteric access sheaths were more frequently used in Group 2 (39.5% vs. 56.8%, p = 0.021). The operation time was significantly longer in Group 2 (p < 0.001). SFR after a single procedure was 84.7% in Group 1 and 63.7% in Group 2. Overall complication rates in Groups 1 and 2 were 7.6% and 33.3%, respectively. The most frequently reported complication in both groups was post-operative fever (4.4% vs. 14%, p = 0.004). The rate of Clavien I/II complications in groups 1 and 2 was 6% and 25.1%, respectively (p < 0.05). The rate of Clavien ≥ III complications in groups 1 and 2 was 1.6% and 8.1%, respectively (p < 0.05). On multivariate analysis, total operation time, stone size and multiplicity were significant predictors of residual fragments. Conclusions RIRS can be performed in paediatric cases with large and multiple stone burdens, but the complication rate is significantly higher when compared to smaller stones.
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Affiliation(s)
- Patrick Juliebø‐Jones
- Department of Clinical MedicineUniversity of BergenBergenNorway
- Department of UrologyHaukeland University HospitalBergenNorway
- Department of UrologyUniversity Hospital SouthamptonSouthamptonUK
| | - Vineet Gauhar
- Department of UrologyNg Teng Fong HospitalSingaporeSingapore
| | - Ee Jean Lim
- Department of UrologySingapore General HospitalSingaporeSingapore
| | - Olivier Traxer
- Department of Urology Hôpital TenonSorbonne UniversityParisFrance
| | | | - Daniele Castellani
- Urology Division, Azienda Ospedaliero‐Universitaria Ospedali Riuniti Di AnconaUniversità Politecnica Delle MarcheAnconaItaly
| | - Khi Yung Fong
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Anna Bujons
- Urology DepartmentAutonomous University of Barcelona, Fundació PuigvertBarcelonaSpain
| | - Deepak Ragoori
- Department of UrologyAsian Institute of Nephrology and Urology, Banjara HillsHyderabadIndia
| | - Anil Shrestha
- Department of Urology, National Academy of Medical SciencesBir HospitalKathmanduNepal
| | | | | | - Cagri Akin Sekerci
- Department of UrologyMarmara University School of MedicineIstanbulTurkey
| | - Yiloren Tanidir
- Department of UrologyMarmara University School of MedicineIstanbulTurkey
| | - Jeremy Yuen‐Chun Teoh
- Department of Surgery, S.H. Ho Urology CentreThe Chinese University of Hong KongSha TinHong Kong, China
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Somani BK, Massella V, Pietropaolo A, Ripa F, Sinha MM, Griffin S. Safety and Efficacy of "Dusting and Pop-Dusting" with High-Power Laser for Treatment of Large Pediatric Stones with Ureteroscopy and Lasertripsy: Prospective Outcomes from a University Teaching Hospital. J Endourol 2024; 38:416-420. [PMID: 38323560 DOI: 10.1089/end.2023.0150] [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: 02/08/2024] Open
Abstract
Introduction: The wide use of high-power laser has changed the landscape of ureteroscopy and lasertripsy (URSL). We wanted to look at the role and outcomes of high-power holmium:yttrium-aluminum-garnet laser for URSL in pediatric stone disease. Methods: A prospective analysis of consecutive pediatric patients treated with "Dusting and Pop-dusting" using a high-power laser was done between January 2016 and March 2022. The project was registered with our audit committee. Data were analyzed for patient demographics, stone characteristics, operative details, procedural outcomes, and complications. Stone-free rate (SFR) was defined as fragments ≤2 mm on postoperative ultrasound imaging 2-3 months after the procedure. Results: A total of 35 patients underwent 43 procedures (1.2 procedure/patient) during the study period with a mean age of 9.4 years (range 1-16 years) and a male:female ratio of 13:22. The stone location was in the kidney in 32 (91.4%) patients of which 8 were in multiple renal locations. The mean stone size was 18 mm (range 10-39 mm), with the pre- and post-stent rates of 37% and 56%, respectively. An access sheath was used in 19 (44%) procedures. The overall SFR on ultrasound scan was 94% (n = 33) with no procedural complications noted in our series and a mean length of stay of 0.9 days. Conclusion: Pediatric URSL using a high-power laser achieves a high SFR even for large and multiple renal stones with no complications noted in our prospective series. Parents must, however, be counseled about the need for staged procedures, which might be needed for large stones.
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Affiliation(s)
- Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Virginia Massella
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Francesco Ripa
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Mriganka Mani Sinha
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Stephen Griffin
- Southampton Children's Hospital NHS Trust, Southampton, United Kingdom
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Pietropaolo A, Geraghty R, Griffin S, Skolarikos A, Seitz C, Bujons A, Sriprasad S, Subramonian S, Smith D, Contreras P, Bernardo N, Esperto F, Emiliani E, De Coninck V, Tailly T, Keller EX, Talso M, Tonyali S, Sener ET, Hameed BMZ, Tzelves L, Ventimiglia E, Juliebø-Jones P, Mykoniatis I, Tsaturyan A, Bres-Niewada E, Somani BK. Worldwide trends of practice and intervention in paediatric endourology: comparison of European versus Non-European responses. Cent European J Urol 2023; 76:245-250. [PMID: 38045778 PMCID: PMC10690392 DOI: 10.5173/ceju.2023.79] [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: 05/08/2023] [Revised: 07/19/2023] [Accepted: 08/28/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction The area of paediatric endourology is unique and is recognised to be challenging, and it requires a certain level of focused training and expertise. Our aim was to conduct a worldwide survey in order to gain an overview regarding the current practice patterns for minimally invasive treatments of paediatric upper urinary tract stone patients. Material and methods The survey was distributed between December 2021 and April 2022 through urology sections and societies in United Kingdom, Latin America and Asia. The survey was made up of 20 questions and it was distributed online using the free online Google Forms (TM). Results 221 urologists answered the survey with 56 responses each from India, South America and UK and 53 responses from the rest of Europe (15 countries). In total, 163 responders (73.7%) managed paediatric stone patients in their daily practice. Of the responders, 60.2% were adult urologists and 39.8% were paediatric urologists. 12.9% adult urologists and 20.4% paediatric urologists run independent clinics while some run combined adult and paediatric clinics sometimes with the support of the nephrologists. Only 33.9% urologists offered all surgical treatments [extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), ureteroscopy (URS) and retrograde intrarenal surgery (RIRS)]. Conclusions Treatment of paediatric stones can vary according to country and legislations. Based on the results of this survey, minimally invasive methods such as URS and mini PCNL seem to have become more popular. In most institutions a collaboration exists between adult and paediatric urologists, which is the key for a tailored decision making, counselling and treatment success.
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Affiliation(s)
- Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, Arnhem, Netherlands
| | - Robert Geraghty
- Department of Urology, Freeman Hospital, Freeman Road, Newcastle-Upon-Tyne, United Kingdom
| | - Stephen Griffin
- Department of Paediatric Urology, University Hospitals Southampton, NHS Trust, Southampton, United Kingdom
| | - Andreas Skolarikos
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christian Seitz
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Anna Bujons
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Seshadri Sriprasad
- Department of Urology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, United Kingdom
| | - Subu Subramonian
- Department of Urology, Queen Elizabeth Hospital in Birmingham, Brimingham, United Kingdom
| | - Daron Smith
- Institute of Urology, University College Hospital London, London, United Kingdom
| | - Pablo Contreras
- Department of Urology, Hospital Alemán de Buenos Aires, Buenos Aires, Argentina
| | - Norberto Bernardo
- Department of Urology, Hospital del Clinicas Jose de San Martin, Buenos Aires, Argentina
| | - Francesco Esperto
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, Arnhem, Netherlands
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Esteban Emiliani
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, Arnhem, Netherlands
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Vincent De Coninck
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, Arnhem, Netherlands
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Thomas Tailly
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, Arnhem, Netherlands
- University Hospital Ghent, Department of Urology, Gent, Oost-Vlaanderen, Belgium
| | - Etienne X. Keller
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, Arnhem, Netherlands
- Department of Urology, University hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michele Talso
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, Arnhem, Netherlands
- Department of Urology, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milano, Italy
| | - Senol Tonyali
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, Arnhem, Netherlands
- Department of Urology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Emre T. Sener
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, Arnhem, Netherlands
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - BM Zeeshan Hameed
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, Arnhem, Netherlands
- Department of Urology, Father Muller Medical College, Karnataka, India
| | - Lazaros Tzelves
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, Arnhem, Netherlands
- Institute of Urology, University College Hospital London, London, United Kingdom
| | - Eugenio Ventimiglia
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, Arnhem, Netherlands
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS, Ospedale San Raffaele, Milan, Italy
| | - Patrick Juliebø-Jones
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, Arnhem, Netherlands
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Ioannis Mykoniatis
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, Arnhem, Netherlands
- Department of Urology, Aristotle University of Thessaloniki, Greece
| | - Arman Tsaturyan
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, Arnhem, Netherlands
- Department of Urology, Erebouni Medical Center, Yerevan, Armenia
| | - Ewa Bres-Niewada
- Department of Urology, Roefler Memorial Hospital, Pruszków, Poland
- Faculty of Medicine, Łazarski University, Warsaw, Poland
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, Arnhem, Netherlands
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Juliebø-Jones P, Somani BK, Tzelves L, Æsøy MS, Gjengstø P, Moen CA, Beisland C, Ulvik Ø. AUTHOR REPLY. Urology 2023; 177:47. [PMID: 37225597 DOI: 10.1016/j.urology.2023.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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.
| | | | - Lazaros Tzelves
- EAU YAU Urolithiasis group; Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece
| | | | - 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
| | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Juliebø-Jones P, Moen CA, Haugland JN, Gjengstø P, Æsøy MS, Beisland C, Ulvik Ø. Ureteroscopy for Stone Disease in Extremely Elderly Patients (≥85 Years): Outcomes and Lessons Learned. J Endourol 2023; 37:245-250. [PMID: 36458461 DOI: 10.1089/end.2022.0665] [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: 12/03/2022] Open
Abstract
Introduction: The volume of surgeries including ureteroscopy (URS) performed for urolithiasis is increasing. This includes for the elderly population. The aim of this study was to evaluate the outcomes of URS in extremely elderly patients and identify any lessons that could be learned for clinical practice and treatment planning. Materials and Methods: Retrospective analysis was performed of consecutive patients aged 85 years and older undergoing URS between 2010 and 2022 at our tertiary center. Uni- and multivariable logistic regression analyses were performed to identify possible risk factors for complications. Survival analysis, stratified by age-adjusted Charlson Comorbidity index (ACCI), was performed using the Kaplan-Meier method as well as the log-rank test. Results: Sixty-four URS procedures were performed on 51 patients (mean age 88 years, range 85-97). Mean ACCI score was 7 (range 4-13) and most patients were American Society Anesthesiologists 3 (78%). Mean operative time and hospital stay were 60 minutes (range 15-120) and 2 days (range 0-6), respectively. At 3-month follow-up imaging, 92% were stone free (zero fragments). Intraoperative complication rate was 14% and in three cases (5%), early termination of the procedure was necessary. Eight patients (13%) suffered a complication before discharge. Eighteen patients (28%) had documented late complications after their surgery. The complication rate when combining early and late adverse events was 41%. One year mortality rate was 23%. Multivariable regression analysis revealed that operation time and ACCI >7 were significant predictors of complications after surgery. Survival probability was significantly worse in those patients with ACCI >7 (p = 0.0083). Conclusion: The morbidity burden of URS in the extremely elderly is higher than for other population groups. Risk should be considered carefully and implementation of ACCI can aid this process. High scores should prompt strong consideration of a conservative approach. Operation time should be kept to a minimum wherever possible.
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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
| | | | | | - 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
| | - Øyvind Ulvik
- 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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