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Güven S, Tokas T, Tozsin A, Haid B, Lendvay TS, Silay S, Mohan VC, Cansino JR, Saulat S, Straub M, Tur AB, Akgül B, Samotyjek J, Lusuardi L, Ferretti S, Cavdar OF, Ortner G, Sultan S, Choong S, Micali S, Saltirov I, Sezer A, Netsch C, de Lorenzis E, Cakir OO, Zeng G, Gozen AS, Bianchi G, Jurkiewicz B, Knoll T, Rassweiler J, Ahmed K, Sarica K. Consensus statement addressing controversies and guidelines on pediatric urolithiasis. World J Urol 2024; 42:473. [PMID: 39110242 PMCID: PMC11306500 DOI: 10.1007/s00345-024-05161-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/05/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE We aimed to investigate controversial pediatric urolithiasis issues systematically, integrating expert consensus and comprehensive guidelines reviews. METHODS Two semi-structured online focus group meetings were conducted to discuss the study's need and content, review current literature, and prepare the initial survey. Data were collected through surveys and focus group discussions. Existing guidelines were reviewed, and a second survey was conducted using the Delphi method to validate findings and facilitate consensus. The primary outcome measures investigated controversial issues, integrating expert consensus and guideline reviews. RESULTS Experts from 15 countries participated, including 20 with 16+ years of experience, 2 with 11-15 years, and 4 with 6-10 years. The initial survey identified nine main themes, emphasizing the need for standardized diagnostic and treatment protocols and tailored treatments. Inter-rater reliability was high, with controversies in treatment approaches (score 4.6, 92% agreement), follow-up protocols (score 4.8, 100% agreement), and diagnostic criteria (score 4.6, 92% agreement). The second survey underscored the critical need for consensus on identification, diagnostic criteria (score 4.6, 92% agreement), and standardized follow-up protocols (score 4.8, 100% agreement). CONCLUSION The importance of personalized treatment in pediatric urolithiasis is clear. Prioritizing low-radiation diagnostic tools, effectively managing residual stone fragments, and standardized follow-up protocols are crucial for improving patient outcomes. Integrating new technologies while ensuring safety and reliability is also essential. Harmonizing guidelines across regions can provide consistent and effective management. Future efforts should focus on collaborative research, specialized training, and the integration of new technologies in treatment protocols.
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Affiliation(s)
- S Güven
- Department of Urology, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey.
| | - T Tokas
- Department of Urology, University General Hospital of Heraklion, Athens, Greece
| | - A Tozsin
- Department of Urology, Trakya University School of Medicine Hospital, Edirne, Turkey
| | - B Haid
- Ordensklinikum Linz, Barmherzige Scwestern Hospital, Linz, Austria
| | - T S Lendvay
- Department of Urology, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - S Silay
- Istanbul Medipol University, Istanbul, Turkey
| | - V C Mohan
- Preeti Urology Hospital, Hyderabad, Telangana, India
| | - J R Cansino
- Hospital Universitario La Paz, Madrid, Spain
| | - S Saulat
- Department of Urology, Tabba Kidney Institute, Karachi, Pakistan
| | - M Straub
- Department of Urology, Technical University Munich, Munich, Germany
| | - A Bujons Tur
- Urology Department, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - B Akgül
- Department of Urology, Trakya University School of Medicine Hospital, Edirne, Turkey
| | - J Samotyjek
- Pediatric Surgery and Urology Clinic CMKP in Dziekanów Leśny, Dziekanów Leśny, Poland
| | - L Lusuardi
- Department of Urology, Paracelsus Medical University Salzburg University Hospital, Urology, Salzburg, Austria
| | - S Ferretti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - O F Cavdar
- Department of Urology, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - G Ortner
- Department of Urology, General Hospital Hall I.T, Tirol, Austria
| | - S Sultan
- Department of Urology, Menoufia University Hospitals, Shebeen El Kom, Egypt
| | - S Choong
- Institute of Urology, University College Hospital, London, UK
| | - S Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - I Saltirov
- Department of Urology and Nephrology at Military Medical Academy, Sofia, Bulgaria
| | - A Sezer
- Pediatric Urology Clinic, Konya City Hospital, Konya, Turkey
| | - C Netsch
- Asklepios Klinik BarmbekAbteilung Für Urologie, Hamburg, Germany
| | - E de Lorenzis
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - O O Cakir
- King's College London, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - G Zeng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - A S Gozen
- Department of Urology, Medius Clinic, Ostfildern, Germany
| | - G Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - B Jurkiewicz
- Pediatric Surgery and Urology Clinic CMKP in Dziekanów Leśny, Dziekanów Leśny, Poland
| | - T Knoll
- Klinikum Sindelfingen-Boeblingen, Sindelfingen, Germany
| | - J Rassweiler
- Department of Urology and Andrology, Danube Private University, Krems, Austria
| | - K Ahmed
- King's College London, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, UK
- Sheikh Khalifa Medical City, Abu Dhabi, UAE
- Khalifa University, Abu Dhabi, UAE
| | - K Sarica
- Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
- Department of Urology, Biruni University Medical School, Istanbul, Turkey
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Troncoso B. Outcomes of retrograde ureteroscopy in Chinese infants and toddlers under 3 years old with ureteric stones from a single center. J Pediatr Urol 2024; 20:400-401. [PMID: 38302318 DOI: 10.1016/j.jpurol.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 02/03/2024]
Affiliation(s)
- B Troncoso
- Hospital Luis Calvo Mackenna, Santiago, Chile; Hospital San Juan De Dios, Santiago, Chile; Clinica MEDS, Santiago, Chile.
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Davis SO, Zubair A, Anyakora C, Igbokwe MC, Haladu Z, Ajibade AF, Noah O, Agyeman C, Oisamokhai K, Enemoh O, Ikuborije P, Nwokeocha ES, Ajari O, Adejala I, Mastaki VM, Akinro O. Paediatric Renal Stone Management in Africa: A Scoping Review and Analysis of Current Practices. Cureus 2024; 16:e56819. [PMID: 38654778 PMCID: PMC11037113 DOI: 10.7759/cureus.56819] [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] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Renal stones are solid deposits formed from minerals and salts that develop within the kidneys and urinary tract. While the condition is more common among adults, children and even infants can also be affected. There is an increasing incidence of paediatric renal stones in Africa alongside multiple challenges faced in managing the condition. This scoping review aimed to provide an overview of the management modalities of paediatric renal stones in Africa. This study utilised Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. A systematic search was conducted in three electronic databases: PubMed, African Journal Online (AJOL), and Google Scholar, with 1,180 articles curated. After extensive examination, 10 articles satisfied the inclusion criteria. The review found that calcium oxalate stones were the most prevalent type, accounting for 34.03% of cases, followed by whewellite stones and ammonium urate stones. The most frequent location for stones was the kidney, and the most common symptom was pain. Abdominopelvic ultrasound was the most frequently utilised investigation. Of the 886 patients managed for renal stones, 75.4% were managed surgically, 2.9% medically, and 21.7% spontaneously resolved without intervention. This review identifies opportunities for improving the management of paediatric renal stones in Africa, including the need for standardised diagnostic and treatment protocols and the development of evidence-based guidelines tailored to the African context. Overall, this scoping review provides valuable insights into the patterns and management of paediatric renal stones in Africa and highlights the need for further research to improve the management of this condition in the region.
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Affiliation(s)
| | | | | | | | | | | | - Olumide Noah
- Urology, Surgery Interest Group of Africa, Lagos, NGA
| | | | | | - Obinna Enemoh
- Urology, Surgery Interest Group of Africa, Lagos, NGA
| | | | | | | | - Isaac Adejala
- Urology, Surgery Interest Group of Africa, Lagos, NGA
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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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Mohamed ER, Elmogazy HM, Zanaty AK, Elsharkawi AM, Riad AM, Badawy AA. Extracorporeal shock wave lithotripsy for treatment of large pediatric renal pelvic stone burden more than 2 cm. J Pediatr Urol 2023; 19:561.e1-561.e11. [PMID: 37414650 DOI: 10.1016/j.jpurol.2023.06.017] [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: 09/15/2022] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The high recurrence rates in pediatric urolithiasis indicate the need for none invasive or a minimally invasive treatment such as SWL. Therefore, EAU, ESPU and AUA recommend SWL as a first line treatment for renal calculi ≤ 2, and RIRS or PCNL for renal calculi > 2 cm. SWL is superior to RIRS and PCNL as it is inexpensive, outpatient procedure, and it has a high SFR in well selected cases specially pediatrics. On the other hand, SWL therapy has a limited efficacy with a lower SFR, and high retreatment rate and/or additional interventions for treatment of larger and harder renal calculi. OBJECTIVE We carried out this study to evaluate the efficacy and safety of SWL for treatment of renal stones > 2 cm to extend its indications for pediatric renal calculi. METHODS Between January 2016 and April 2022, we reviewed the records of patients with renal calculi treated by SWL, mini-PCNL, RIRS and open surgery in our institution. Forty-nine eligible children aged 1-5 years old, presented with renal pelvic and/or calyceal calculi measuring 2-3.9 cm and underwent SWL therapy were picked up and participated in the study. The data of an additional eligible 79 children with the same age and had renal pelvic and/or calyceal calculi > 2 cm up to stag horn calculi and underwent mini-PCNL, RIRS and open renal surgery were also picked up and participated in the study. We retrieved the following preoperative data from the records of the eligible patients; age, gender, weight, length, radiological findings (stone size, side, site, number and radio-density), renal function tests, routine laboratory findings, and urine analysis. The outcomes data in the form of; operative time, fluoroscopy time, hospital stay, SFRs, retreatment rates and complication rates were also retrieved from the records of patients treated with SWL and other techniques. Also, we collected the SWL characteristics in terms of; position, number and frequency of shocks, voltage, time of the session and U/S monitoring to assess stone fragmentation. All SWL procedures were performed according to the institution's standards. RESULTS The mean age of patients treated with SWL was 3.23 ± 1.19 years old, the mean size of the treated calculi was 2.31 ± 0.49 and the mean length of the SSD was 8.2 ± 1.4 cm. All patients had NCCT scan and the mean radio-density of the treated calculi was 572 ± 169.08 HUs based on NCCT scans Table (1). Single- and two-session SFRs of SWL therapy were 75.5% (37/49 patients) and 93.9% (46/49 patients), respectively. The overall success rate was 95.9% (47/49 patients) after three-session of SWL. Complications experienced by 7 patients (14.3%) in the form of fever (4.1%), vomiting (4.1%), abdominal pain (4/1%), and hematuria (2%). All complications were managed in outpatient settings. Our results were obtained on the basis of preoperative NCCT scans for all patients and postoperative plain KUB films and real-time abdominal U/S. Furthermore, single-session SFRs for SWL, mini-PCNL, RIRS and open surgery were 75.5%, 82.1%, 73.7% and 90.6%, respectively. Two-session SFRs by the same technique were 93.9%, 92.8%, and 89.5% for SWL, mini-PCNL and RIRS, respectively. A lower overall complication rate and higher overall SFR were found with SWL therapy compared to other techniques, Fig. (1). DISCUSSION Being a non-invasive outpatient procedure with a low complication rate and good spontaneous passage of stone fragments is the main advantage of SWL. In this study, the overall SFR is 93.9% where 46 out of 49 patients were completely rendered stone free after three session of SWL with overall success rate 95.9%. Badawy et al. reported overall success rates of 83.4% for renal stones with a mean stone size of 12.5 ± 7.2 mm. In children with renal stones measuring 18.2 mm, Ramakrishnan et al. reported a 97% SFR in accordance with our results. The high overall success rate (95.9%) and SFR (93.9%) in our research were attributed to the regular use of ramping procedure, low shock wave rate, percussion diuretics inversion (PDI) approach and alpha blocker therapy in all participants and short SSD. The limitations of our study are small sample of patients and its retrospective nature. CONCLUSION The non-invasive nature and replicability of the SWL procedure, along with the high success and low complication rates, give us a new insight to consider its application for treating pediatric renal calculi > 2 cm over the other more invasive techniques. Short SSD, the use of ramping procedure, low shock wave rate, 2 min break, PDI approach and alpha blockers therapy help better success of SWL. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | | | - Ahmed Kalaf Zanaty
- Urology Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | | | - Ahmed Mahmoud Riad
- Urology Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
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Kakinoki H, Yamaguchi Y, Kakinoki Y, Udo K, Tobu S, Noguchi M. Pediatric cystine stone successfully treated by mini-percutaneous nephrolithotripsy and antegrade ureteroscopy. IJU Case Rep 2023; 6:137-140. [PMID: 36875000 PMCID: PMC9978058 DOI: 10.1002/iju5.12570] [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: 10/27/2022] [Accepted: 12/13/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction Cystinuria is often diagnosed by large renal stone for pediatric patients. The patients suffer from recurrence of stone disease, develop the chronic kidney disease and fall into end-stage renal failure. Total removal of stone at the first intervention and prevention of recurrence are essential. Although, it is difficult to treat the pediatric stone patients for their anatomical feature. Case presentation We report three cases of pediatric cystine stone patients (two 4-year-old boys and a 9-year-old girl) successfully treated by mini-percutaneous nephrolithotripsy and antegrade ureteroscopy. We could remove stones completely in all three cases, and the patients did not suffer from major complications. Conclusion It is essential to select the surgical approach, the endourological device, and the patient's position which is suitable for the age, the body size, and the condition of stones at the initial intervention of pediatric cystine stone.
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Affiliation(s)
- Hiroaki Kakinoki
- Department of Urology, Faculty of Medicine Saga University Saga Japan
| | - Yukako Yamaguchi
- Department of Urology, Faculty of Medicine Saga University Saga Japan
| | - Yuka Kakinoki
- Department of Urology, Faculty of Medicine Saga University Saga Japan
| | - Kazuma Udo
- Department of Urology, Faculty of Medicine Saga University Saga Japan
| | - Shohei Tobu
- Department of Urology, Faculty of Medicine Saga University Saga Japan
| | - Mitsuru Noguchi
- Department of Urology, Faculty of Medicine Saga University Saga Japan
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Abstract
The incidence of kidney stones in children is increasing. Approximately two-thirds of pediatric cases have a predisposing cause. Children with recurrent kidney stones have an increased higher risk of developing chronic kidney. A complete metabolic workup should be performed. Ultrasound examination is the initial imaging modality recommended for all children with suspected nephrolithiasis. A general dietary recommendation includes high fluid consumption, dietary salt restriction, and increased intake of vegetables and fruits. Depending on size and location of the stone, surgical intervention may be necessary. Multidisciplinary management is key to successful treatment and prevention.
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Affiliation(s)
- Larisa Kovacevic
- Department of Pediatric Urology, Michigan State University and Central Michigan University, Stone Clinic, Children's Hospital of Michigan, 3901 Beaubien Boulevard, Detroit 48201, MI, USA.
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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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Paraboschi I, Gnech M, De Marco EA, Minoli DG, Bebi C, Zanetti SP, Manzoni G, Montanari E, Berrettini A. Pediatric Urolithiasis: Current Surgical Strategies and Future Perspectives. Front Pediatr 2022; 10:886425. [PMID: 35757114 PMCID: PMC9218273 DOI: 10.3389/fped.2022.886425] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/16/2022] [Indexed: 12/23/2022] Open
Abstract
New technological innovations and cutting-edge techniques have led to important changes in the surgical management of pediatric urolithiasis. Miniaturized technologies and minimally invasive approaches have been increasingly used in children with urinary stones to minimize surgical complications and improve patient outcomes. Moreover, the new computer technologies of the digital era have been opening new horizons for the preoperative planning and surgical treatment of children with urinary calculi. Three-dimensional modeling reconstructions, virtual, augmented, and mixed reality are rapidly approaching the surgical practice, equipping surgeons with powerful instruments to enhance the real-time intraoperative visualization of normal and pathological structures. The broad range of possibilities offered by these technological innovations in the adult population finds increasing applications in pediatrics, offering a more detailed visualization of small anatomical structures. This review illustrates the most promising techniques and devices to enhance the surgical treatment of pediatric urolithiasis in children, aiming to favor an early adoption and to stimulate more research on this topic.
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Affiliation(s)
- Irene Paraboschi
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Gnech
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Erika Adalgisa De Marco
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Guido Minoli
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carolina Bebi
- Department of Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Gianantonio Manzoni
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Alfredo Berrettini
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Robotically Assisted Surgery in Children—A Perspective. CHILDREN 2022; 9:children9060839. [PMID: 35740776 PMCID: PMC9221697 DOI: 10.3390/children9060839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/16/2022] [Accepted: 06/03/2022] [Indexed: 11/26/2022]
Abstract
The introduction of robotically assisted surgery was a milestone for minimally invasive surgery in the 21st century. Currently, there are two CE-approved robotically assisted surgery systems for use and development in pediatrics. Specifically, tremor filtration and optimal visualization are approaches which can have enormous benefits for procedures in small bodies. Robotically assisted surgery in children might have advantages compared to laparoscopic or open approaches. This review focuses on the research literature regarding robotically assisted surgery that has been published within the past decade. A literature search was conducted to identify studies comparing robotically assisted surgery with laparoscopic and open approaches. While reported applications in urology were the most cited, three other fields (gynecology, general surgery, and “others”) were also identified. In total, 36 of the publications reviewed suggested that robotically assisted surgery was a good alternative for pediatric procedures. After several years of experience of this surgery, a strong learning curve was evident in the literature. However, some authors have highlighted limitations, such as high cost and a limited spectrum of small-sized instruments. The recent introduction of reusable 3 mm instruments to the market might help to overcome these limitations. In the future, it can be anticipated that there will be a broader range of applications for robotically assisted surgery in selected pediatric surgeries, especially as surgical skills continue to improve and further system innovations emerge.
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Zhao FZ, Xia JZ, Li J, Tang L, Li CM, Wang XC, Tian Y. External validation of efficacy and reliability of different retrograde intrarenal surgery (RIRS) scoring systems for pediatric nephrolithiasis. J Pediatr Urol 2022; 18:313.e1-313.e6. [PMID: 35474163 DOI: 10.1016/j.jpurol.2022.03.023] [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: 10/31/2021] [Revised: 03/20/2022] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Retrograde Intrarenal Surgery (RIRS) is one of minimally invasive procedures for pediatric upper urinary stones. However, a RIRS predictive system for children to evaluate postoperative stone free rate (SFR) is still unavailable. OBJECTIVE The aim of this study is to validate the efficacy and reliability of different RIRS scoring systems for children. STUDY DESIGN We collected clinical data of 137 pediatric patients treated with RIRS in our center between 2014 and 2021. All the predictors were acquired by preoperative non-contrast CT or CT urography. Receiver Operative Curve (ROC) and Area Under Curve (AUC) were showed to compare the predictive power of different models. RESULTS A total of 162 RIRS procedures were performed for these 137 pediatric patients. Median surgical duration, irrigation volume and hospitalization were 30 (20, 40) min, 500 (300, 1000) ml and 6 (4, 7) days, respectively. Overall SFR and complication rate was 79.6% (129/162) and 29.2% (40/137), respectively. Significant difference was detected between non-stone free group and stone free group in terms of stone complexity (p < 0.001), cumulative stone sizes [2.3 (2.0, 3.5) cm vs. 1.5 (1.0, 2.0) cm, p < 0.001], RUS groups (p < 0.001), S-ReSC groups (p < 0.001) and RIRS nomogram score [10 (8, 12) vs. 23 (18, 25), p < 0.001]. Among them, RIRS nomogram presented with the maximum AUC values in comparison with the other two systems (RUS: 0.944 vs. 0.874, p = 0.001; S-ReSC: 0.944 vs. 0.808, p < 0.001). DISCUSSION We reported the largest sample size of pediatric patients treated with RIRS in our center. Similar with previous studies, RIRS is an efficacious and safe option for pediatric patients. RIRS nomogram showed the best predictive outcome due to the inclusion of multiple parameters, but an innovative predictive system based on pediatric clinical data is warranted in the future. CONCLUSION Among the three scoring systems, RIRS nomogram showed the most optimal predictive power of postoperative SFR for pediatric patients.
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Affiliation(s)
- Fang-Zhou Zhao
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, China.
| | - Jun-Zhe Xia
- Department of Urology, Beijing Chuiyangliu Hospital, Beijing, China.
| | - Jun Li
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, China.
| | - Lei Tang
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, China.
| | - Chun-Ming Li
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, China.
| | - Xiao-Chuan Wang
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, China.
| | - Ye Tian
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, China.
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Comment on "Outcomes of ureteroscopy (URS) for stone disease in the paediatric population: results of over 100 URS procedures from a UK tertiary centre". World J Urol 2022; 40:1263-1264. [PMID: 34037817 DOI: 10.1007/s00345-021-03737-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/15/2021] [Indexed: 12/13/2022] Open
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13
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Sridharan B, Jagannathan V, Rajesh NG, Viswanathan P. Combined effect of polyacrylic acid and vitamin E in preventing calcium oxalate crystal deposition in the kidneys of experimental hyperoxaluric rats. Cell Biochem Funct 2022; 40:138-149. [PMID: 34981535 DOI: 10.1002/cbf.3683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 12/08/2021] [Accepted: 12/20/2021] [Indexed: 02/05/2023]
Abstract
Our study explores the combined effect of polyacrylic acid and vitamin E as prophylactic and curative agent against ethylene glycol (EG) induced calcium oxalate stone formation in Wistar rats. Male Wistar rats (54) were divided into nine groups, including control. The experimental groups were equally segregated into two for preventive study (4) and curative study (4). Urolithiasis was induced with 0.75% (v/v) EG in drinking water. Polyacrylic acid (10 mg/kg) and vitamin E (300 IU/day) were supplemented from day 1 for preventive and day 30 for curative studies. Restoration of urinary lithogenic factors (calcium, oxalate, phosphate, citrate and magnesium) and renal function (urea and creatinine in serum) by intervening agents were accomplished compared to urolithic rats (P < .001). Abnormal localization and increased expression of Tamm-Horsfall Protein, osteopontin and transferrin were observed in the kidneys of urolithic rats (P < .001) from immunohistochemistry and immunoblotting analysis. Polyacrylic acid and vitamin E supplementation have regulated the expression of the urinary macromolecules. Pro-inflammatory cytokines in kidney were significantly reduced (P < .001) by the intervening agents compared to urolithic rats. Therefore, polyacrylic acid and vitamin E in combination could be a potential formulation for better management of urolithiasis.
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Affiliation(s)
- Badrinathan Sridharan
- Renal Research Lab, Centre for Biomedical Research, Department of Biosciences, Vellore Institute of Technology, Vellore, India
- Department of Applied Chemistry, Chaoyang University of Technology, Taichung, Taiwan, Republic of China
| | - Venkataseshan Jagannathan
- Renal Research Lab, Centre for Biomedical Research, Department of Biosciences, Vellore Institute of Technology, Vellore, India
| | - Nachiappa Ganesh Rajesh
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Pragasam Viswanathan
- Renal Research Lab, Centre for Biomedical Research, Department of Biosciences, Vellore Institute of Technology, Vellore, India
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14
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Softness KA, Kurtz MP. Pediatric Stone Surgery: What Is Hot and What Is Not. Curr Urol Rep 2022; 23:57-65. [PMID: 35133545 DOI: 10.1007/s11934-022-01089-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW We aim to highlight recent advances in technology and techniques for surgical management of urinary tract calculi in pediatric patients. RECENT FINDINGS Percutaneous nephrolithotomy (PCNL) is classically performed in the prone position. The supine PCNL was first attempted to overcome the shortcomings of difficult airway access, patient and surgeon discomfort. The supine PCNL, and subsequent modifications, has been successfully described in the pediatric population. Classically, PCNL has also been classically concluded with obligate placement of a nephrostomy tube and bladder catheter. Recently, tubeless and totally tubeless PCNL reduces pain and duration of hospitalization with satisfactory surgical outcomes in children. Finally, we describe the use of thulium laser technology, which offers improved efficacy in stone treatment and may supplant the current dominant technologies in coming years. Recent advances in pediatric stone surgery include supine PCNL, miniaturized PCNL instrumentation, tubeless procedures, and thulium laser technology.
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Affiliation(s)
- Kenneth A Softness
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
| | - Michael P Kurtz
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, USA
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15
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Marte A. Staghorn stone in megapolycalicosis in a child: Still the case for open surgery? Case report. LA PEDIATRIA MEDICA E CHIRURGICA 2022; 44. [DOI: 10.4081/pmc.2022.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 01/19/2022] [Indexed: 11/23/2022] Open
Abstract
We here report a rare case of congenital megapolycalicosis in a 14-year-old girl complicated by a 24-mm staghorn stone and numerous calculi at the level of all caliceal groups that had become symptomatic in recent weeks with malaise, hematuria, and urinary tract infection. Among the various therapeutic options, we opted for open surgery. The staghorn stone was removed by pyelotomy, and washout of the caliceal cavities released numerous microcalculi of 1.5−9 mm in size that were then removed. To our knowledge, this is the first case of pediatric megacapolycalicosis complicated by staghorn stone, which presents complex problems for the diagnosis and therapy.
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16
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Sridharan B, Jagannathan V, Rajesh NG, Viswanathan P. Combined effect of polyacrylic acid and vitamin E in preventing calcium oxalate crystal deposition in the kidneys of experimental hyperoxaluric rats. Cell Biochem Funct 2022. [DOI: https://doi.org/10.1002/cbf.3683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Badrinathan Sridharan
- Renal Research Lab, Centre for Biomedical Research, Department of Biosciences Vellore Institute of Technology Vellore India
- Department of Applied Chemistry Chaoyang University of Technology Taichung Taiwan, Republic of China
| | - Venkataseshan Jagannathan
- Renal Research Lab, Centre for Biomedical Research, Department of Biosciences Vellore Institute of Technology Vellore India
| | - Nachiappa Ganesh Rajesh
- Department of Pathology Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry India
| | - Pragasam Viswanathan
- Renal Research Lab, Centre for Biomedical Research, Department of Biosciences Vellore Institute of Technology Vellore India
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17
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Ahmad T, Minallah N, Khaliq N, Rashid H, Syed M, Almuradi MAA. Safety and efficacy of minimally invasive percutaneous nephrolithotomy for infantile nephrolithiasis. Single centre experience from Pakistan. Front Pediatr 2022; 10:1035964. [PMID: 36726997 PMCID: PMC9885957 DOI: 10.3389/fped.2022.1035964] [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: 09/03/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To assess the efficacy and safety of mini-percutaneous nephrolithotomy (PCNL) for small renal stones 1-2 cm in size in infants less than one year. MATERIAL AND METHODS This descriptive case series was conducted in the department of pediatric urology Institute of Kidney Diseases Peshawar, Pakistan, from March 2019 to March 2022. All the patients underwent mini-PCNL in prone position under GA with 14 Fr access sheath and 10 Fr nephroscope. Stone clearance was assessed by non-contrast CT KUB at 30th postoperative day. Patients with no residual fragments on the non-contrast CT KUB were defined as stone-free. Patients with residual fragments of any size were defined as procedure failure. Safety was determined in terms of intra and postoperative complications. RESULTS A total of 51 infants were included in the study. The mean age of patients was 9.6 + 1.8 (5-12 month). The mean stone size was 15.8 + 2.7 (10-21) mm in length and 12.3 + 2.2 (8-17) mm in width. PCNL mean operative time was 51.6 ± 7.1 (40-70) minutes. Complete stone clearance at one month was observed in 46 (90.2%) patients. Residual fragments were seen in 5(9.8%) patients with a mean size of 1.6 + 0.4 (0.9-2.0) mm. None of the patients required any additional procedure for clearance of stones. In 7 (13.7%) patients, some post-operative complications were observe, all were grade I complications, including fever in 5(9.8%) and transient hematuria in 2(3.9%) patients. CONCLUSION Mini-PCNL is a safe and effective treatment for renal stones in infants measuring 1-2 cm with high SFR and an acceptable complication rate.
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Affiliation(s)
- Tariq Ahmad
- Department of Pediatric Urology, Institute of Kidney Diseases, Khyber Medical University, Peshawar, Pakistan
| | - Nasrum Minallah
- Department of Urology, Institute of Kidney Diseases, Khyber Medical University, Peshawar, Pakistan
| | - Nida Khaliq
- Department of Community Medicine, Fazaia Medical Air University, Islamabad, Pakistan
| | - Hania Rashid
- Department of Biochemistry, Fazaia Medical Air University, Islamabad, Pakistan
| | - Misbah Syed
- Department of Urology, Khyber Teaching Hospital, Khyber Medical University, Peshawar, Pakistan
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18
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Wong YS, Lo KL, Pang KKY, Tam YH. A combined approach of robot-assisted laparoscopic pyeloplasty and flexible endoscopy to treat concomitant ureteropelvic junction obstruction and calyceal stones in children: Technical considerations and review of the literature. Front Pediatr 2022; 10:1017722. [PMID: 36389392 PMCID: PMC9650079 DOI: 10.3389/fped.2022.1017722] [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: 08/12/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
The management of children with concomitant ureteropelvic junction (UPJ) obstruction and calyceal stones remains challenging. The various treatment options available for pediatric nephrolithiasis may require multiple sessions, and the techniques by themselves are not designed for simultaneous correction of UPJ obstruction. Recently, success in combining robot-assisted laparoscopic pyeloplasty (RALP) and flexible endoscopy has been reported by multi-institutional studies to treat children with concomitant UPJ obstruction and renal stones. Given the paucity of technical details of this novel approach in the existing literature, we herein report our techniques to treat two girls aged 6 and 10 years who had concomitant UPJ obstruction and multiple stones in mid- and lower poles calyces. Three robotic ports were used without any assistant ports. A flexible endoscope, either a cystoscope or a single-use ureteroscope, was introduced via the undocked epigastric port to perform nephroscopy and stones removal after the renal pelvis was opened. The rest of the RALP was completed in the usual manner. Technical modifications were employed to facilitate the flexible endoscope to examine the entire calyceal system. Both patients underwent successful surgical procedures by the combined approach without any intra- or post-operative complications. Three and 14 stones were removed from each of the patients respectively. Postoperative investigations demonstrated successful correction of UPJ obstruction and complete stone clearance in both patients. A combined approach of RALP and flexible endoscopy is a safe and effective technique to treat concurrent UPJ obstruction and calyceal stones in children.
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Affiliation(s)
- Yuenshan Sammi Wong
- Department of Surgery, Division of Paediatric Surgery & Paediatric Urology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.,Department of Surgery, Hong Kong Children's Hospital, Hong Kong, China
| | - Ka Lun Lo
- Department of Surgery, Division of Urology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Kristine Kit Yi Pang
- Department of Surgery, Division of Paediatric Surgery & Paediatric Urology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.,Department of Surgery, Hong Kong Children's Hospital, Hong Kong, China
| | - Yuk Him Tam
- Department of Surgery, Division of Paediatric Surgery & Paediatric Urology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.,Department of Surgery, Hong Kong Children's Hospital, Hong Kong, China
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19
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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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20
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Önal B, Kırlı EA. Pediatric stone disease: Current management and future concepts. Turk Arch Pediatr 2021; 56:99-107. [PMID: 34286317 DOI: 10.5152/turkarchpediatr.2021.20273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/27/2020] [Indexed: 12/30/2022]
Abstract
Treatment of pediatric urolithiasis consists of medical and surgical approaches. The main goal of the treatment is to prevent stone recurrence by avoiding multiple surgical interventions. In recent years, many innovations have been reported in the medical diagnostic evaluation protocol and in surgical treatment. According to recent reports, single mutations could be responsible for a larger proportion of renal stones. This etiologic feature holds the potential to change the management in stone prevention from metabolically directed therapy to more specific approaches. In addition, miniaturized instruments have been adopted in clinical practice. In recent years, minimally invasive endoscopic surgery is the treatment of choice in pediatric urolithiasis. This review aims to assess the current literature on medical and surgical treatment options for pediatric urolithiasis. We also aim to provide an overview of potential future advances.
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Affiliation(s)
- Bülent Önal
- Department of Urology, İstanbul University-Cerrahpaşa, Cerahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Elif Altınay Kırlı
- Department of Urology, İstanbul University-Cerrahpaşa, Cerahpaşa Faculty of Medicine, İstanbul, Turkey
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21
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Dogan HS, Asci A, Kahraman O, Gasimov K, Bozaci AC, Tatanis V, Tekgul S. Comparison of Efficiency and Safety of Retrograde Intrarenal Surgery and Micropercutaneous Nephrolithotomy in Pediatric Kidney Stones Smaller than 2 cm: A Prospective Cohort Study. J Endourol 2021; 35:1124-1129. [PMID: 33371783 DOI: 10.1089/end.2020.0624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objective: To compare the safety and efficacy of two minimally invasive surgical techniques used for pediatric stone disease: retrograde intrarenal surgery (RIRS) and micropercutaneous nephrolithotomy (micro-PCNL). Materials and Methods: A prospective study was designed to include children aged <15 years with a single stone <20 mm. Sixty-four patients were assigned to undergo either an RIRS or a micro-PCNL (1:1 ratio). Demographic parameters, stone size, location, operative data, complications, stone-free status, and efficacy quotient were compared. Results: Due to anatomic considerations, seven patients were shifted to the micro-PCNL arm, thus resulting in 39 micro-PCNLs performed vs 25 RIRS in the end. Because of the deviation from planned surgery that was significantly higher in the RIRS group (p = 0.011), the analysis was done in a prospective cohort comparison. Stone-free rates were similar for micro-PCNL and RIRS groups (80% vs 82.2%). The operative (median 60 vs 90 minutes, p < 0.001), fluoroscopy (median 15 vs 30 seconds, p = 0.004), and lithotripsy times (median 15 vs 25 minutes, p = 0.007) were shorter in the RIRS group. However, despite the larger stone size, the efficiency quotient was significantly higher in the micro-PCNL group (82.1% vs 54.1%; p = 0.009). None of the patients experienced significant hematuria requiring blood transfusion, as well as no ureteral orifice obstructive complication was detected within the follow-up period. Conclusion: RIRS and micro-PCNL techniques in children have similar stone-free and complication rates. The operative, fluoroscopy, and lithotripsy times were shorter, deviation from the planned surgery, and the number of sessions under anesthesia was higher in the RIRS group. Despite the larger stone size, efficacy quotient was significantly higher in the micro-PCNL group.
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Affiliation(s)
- Hasan Serkan Dogan
- Department of Urology and Division of Pediatric Urology, Hacettepe University Medical School, Ankara, Turkey
| | - Ahmet Asci
- Department of Urology, Hacettepe University Medical School, Ankara, Turkey
| | - Oguzhan Kahraman
- Department of Urology, Hacettepe University Medical School, Ankara, Turkey
| | - Kamranbay Gasimov
- Department of Urology and Division of Pediatric Urology, Hacettepe University Medical School, Ankara, Turkey
| | - Ali Cansu Bozaci
- Department of Urology and Division of Pediatric Urology, Hacettepe University Medical School, Ankara, Turkey
| | - Vasileios Tatanis
- Department of Urology and Division of Pediatric Urology, Hacettepe University Medical School, Ankara, Turkey
| | - Serdar Tekgul
- Department of Urology and Division of Pediatric Urology, Hacettepe University Medical School, Ankara, Turkey
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22
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Choong S, DE LA Rosette J, Denstedt J, Zeng G, Sarica K, Mazzon G, Saltirov I, Pal SK, Agrawal M, Desai J, Petrik A, Buchholz N, Maroclo MV, Gordon S, Sridhar A. Classification and standardized reporting of percutaneous nephrolithotomy (PCNL): International Alliance of Urolithiasis (IAU) Consensus Statements. Minerva Urol Nephrol 2021; 74:110-118. [PMID: 33439573 DOI: 10.23736/s2724-6051.20.04107-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to reach a consensus in the classification and standardized reporting for the different types of PCNLs. METHODS The RAND/UCLA appropriateness methodology was used to reach a consensus. Thirty-two statements were formulated reviewing the literature on guidelines and consensus on PCNLs, and included procedure specific details, outcome measurements and a classification for PCNLs. Experts were invited to two rounds of input, the first enabled independent modifications of the proposed statements and provided the option to add statements. The second round facilitated scoring of all statements. Each statement was discussed in the third round to decide which statements to include. Any suggestion or disagreement was debated and discussed to reach a consensual agreement. RESULTS Twenty-five recommendations were identified to provide standardized reporting of procedure and outcomes. Consensual scoring above 80% were strongly agreed upon by the panel. The top treatment related outcomes were size of sheath used (99.1%) and position for PCNL (93.5%). The highest ranked Outcome Measures included definition of postoperative hospital length of stay (94.4%) and estimated blood loss (93.5%). CONCLUSIONS The consensus statements will be useful to clarify operative technique, in the design of clinical trials and standardized reporting, and presentation of results to compare outcomes of different types of PCNLs.
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Affiliation(s)
- Simon Choong
- Institute of Urology, University College London Hospitals, London, UK
| | | | - John Denstedt
- Division of Urology, University of Western Ontario, London, ON, Canada
| | - Guohua Zeng
- Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kemal Sarica
- School of Medicine, Department of Urology, Biruni University, Istanbul, Turkey
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy -
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Shashi K Pal
- Department of Urology, Apollo Group of Hospitals and Holy Family Hospital, New Delhi, India
| | - Madhu Agrawal
- Department of Urology, Center for Minimally-Invasive Endourology, Global Rainbow Healthcare, Agra, India
| | - Janak Desai
- Department of Urology, Samved Hospital, Ahmedabad, India
| | - Aleš Petrik
- Department of Urology, Region Hospital Ceske Budejovice, Prague, Czech Republic
| | - Noor Buchholz
- Department of Urology, Sobeh's Vascular and Medical Center, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Marcus V Maroclo
- Unit of Endourology, Hospital de Base of the Federal District, Brasília, Brazil
| | - Stephen Gordon
- Department of Urology, Epsom and St. Helier University Hospitals NHS Trust, Surrey, UK
| | - Ashwin Sridhar
- Institute of Urology, University College London Hospitals, London, UK
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23
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Halinski A, Steyaert H, Wojciech M, Sobolewski B, Haliński A. Endourology Methods in Pediatric Population for Kidney Stones Located in Lower Calyx: FlexURS vs. Micro PCNL (MicroPERC®). Front Pediatr 2021; 9:640995. [PMID: 34095024 PMCID: PMC8175969 DOI: 10.3389/fped.2021.640995] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 04/12/2021] [Indexed: 11/25/2022] Open
Abstract
Kidney stone disease in children is always a therapeutic challenge. It is a multifactorial condition and it should be approached, diagnosed and treated as such. One of the biggest challenges is kidney stones located in the lower renal calyx. There are currently three main surgical techniques to treat this condition: ESWL-Extracorporeal Shock Wave Lithotripsy, RIRS-Retrograde IntraRenal Surgery, and PCNL-PerCutaneous Nephro-Lithotripsy. In pediatric population, the most frequently used method is ESWL, and in the event of failure, endoscopic procedures are the second-best choice. In this article, a sample of 53 children admitted to a tertiary medical center was examined. Thirty-eight of those children underwent flexible URS, while the remaining 15-micro PCNL. The average size of the deposit in the former group was 12.2 mm, against 13.5 mm in the latter. The full Stone Free Rate (SFR) was achieved in RIRS at 84.21 and 86.7% in percutaneous nephrolithotripsy. Flexible ureterorenoscopy and MicroPERC are two comparably effective methods for treating lower calyx stones of any size. However, according to our data, flexible ureterorenoscopy carries a lower risk of complications and inpatient care (with the mean of 3 days). The learning curve for these procedures in pediatric urology is long and relies on a limited number of patients. The number of pediatric patients qualifying for these procedures is restricted also due to the high efficacy of extracorporeal shock wave lithotripsy in pediatric population. Radiation exposure is an important factor in every endoscopy procedure and should never exceed the limits set in the ALARA protocol. ESWL remains to this day the treatment of choice for stone disease in children and can be performed under ultrasound control. For many parents, it is a first-choice treatment preference for their child due to its greater apparent safety, although data on this remains insufficient. Prospective, randomized, multicenter trials are definitely needed.
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Affiliation(s)
- Adam Halinski
- Department of Pediatric Urology, Private Medical Center "Klinika Wisniowa", Zielona Góra, Poland.,Department of Clinical Genetics and Pathomorphology, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland
| | - Henri Steyaert
- Department of Pediatric Surgery, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Magdalena Wojciech
- Department of Mathematical Statistics and Econometrics, Faculty of Mathematics, Computer Science and Econometrics, University of Zielona Góra, Zielona Góra, Poland
| | - Bartłomiej Sobolewski
- Department of Pediatric Urology, Private Medical Center "Klinika Wisniowa", Zielona Góra, Poland
| | - Andrzej Haliński
- Department of Pediatric Urology, Private Medical Center "Klinika Wisniowa", Zielona Góra, Poland
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24
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Zhao FZ, Li J, Tang L, Li CM, Zhang Y, Wang WY, Chen N, Tian Y. Comparison of efficacy and safety of minimally invasive procedures for 10-20 mm pediatric renal Stones-A bayesian network meta-analysis. J Pediatr Urol 2020; 16:771-781. [PMID: 32919900 DOI: 10.1016/j.jpurol.2020.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/19/2020] [Accepted: 08/20/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of various minimally invasive procedures for 10-20 mm pediatric renal stones by Bayesian network meta-analysis (NWA). METHODS We searched clinical comparative trials published in Pubmed, Embase, Cochrane Library from inception to 12 April 2020. Two researchers evaluated the quality and extracted data individually. Data was analyzed using STATA and GEMYC R package. RESULTS The overall network meta-analytic outcome of stone free rate (SFR) in a single session revealed that Retrograde Intrarenal Stone Surgery (RIRS), miniaturized percutaneous nephrolithotomy (mPCNL) and PCNL showed superiority to extracorporeal shockwave lithotripsy (ESWL). Statistical significance was not detected between any intervention from our pooled network analysis of complication rate. SMP was the most likely to ranking in first place to render stone free status, and it also showed the lowest risk possibility of complications. Mini-PCNL had longer operation time and hospitalization than ESWL. The global and loop inconsistency evaluation demonstrated a rather acceptable outcome apart from the comparisons of complication rate between two randomized control studies. DISCUSSION Herein, the authors reviewed and explored the optimal management pattern for pediatric 10-20 mm renal stones. This NWA revealed RIRS and mPCNL could render higher SFR without increasing risk of complications compared with ESWL. Although SMP was deemed to be the best choice in our study, the limited source of study and sample size implied the results required to be further validated. In addition, there were still some problems requiring to be underlined for various surgical options. CONCLUSIONS ESWL was inferior to RIRS, mPCNL and PCNL for 10-20 mm pediatric renal stones, among which SMP might be the most ideal option associated with the least possibility of complications and the highest probability of stone clearance.
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Affiliation(s)
- Fang-Zhou Zhao
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, PR China.
| | - Jun Li
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, PR China.
| | - Lei Tang
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, PR China.
| | - Chun-Ming Li
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, PR China.
| | - Yu Zhang
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, PR China.
| | - Wen-Ying Wang
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, PR China.
| | - Ning Chen
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, PR China.
| | - Ye Tian
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, PR China.
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Kawahara T, Kobayashi K, Hanai T, Kuroda S, Teranishi J, Uemura H. Pediatric bilateral ureteral stone successfully removed using single-use flexible ureteroscopy with a holmium: YAG laser. Clin Case Rep 2020; 8:1073-1075. [PMID: 32577268 PMCID: PMC7303861 DOI: 10.1002/ccr3.2817] [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: 10/10/2019] [Revised: 02/26/2020] [Accepted: 03/05/2020] [Indexed: 11/09/2022] Open
Abstract
A 12-year-old boy received steroid for his minimal change nephrotic syndrome for 10 years, and bilateral renal and ureteral stones and hydronephrosis were observed. Single-use flexible ureteroscopy is usable for pediatric lithotripsy with Ho: YAG laser.
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Affiliation(s)
- Takashi Kawahara
- Departments of Urology and Renal TransplantationYokohama City University Medical CenterYokohamaJapan
| | - Kota Kobayashi
- Departments of Urology and Renal TransplantationYokohama City University Medical CenterYokohamaJapan
| | - Takahiro Hanai
- Departments of Urology and Renal TransplantationYokohama City University Medical CenterYokohamaJapan
| | - Shinnosuke Kuroda
- Departments of Urology and Renal TransplantationYokohama City University Medical CenterYokohamaJapan
| | - Jun‐ichi Teranishi
- Departments of Urology and Renal TransplantationYokohama City University Medical CenterYokohamaJapan
| | - Hiroji Uemura
- Departments of Urology and Renal TransplantationYokohama City University Medical CenterYokohamaJapan
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Asi T, Dogan HS, Altan M, Bozaci AC, Ceylan T, Asci A, Tekgul S. Shockwave lithotripsy for kidney stones as a first-line therapy in children younger than 2 years. J Pediatr Urol 2020; 16:193.e1-193.e6. [PMID: 32037146 DOI: 10.1016/j.jpurol.2020.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The incidence of urolithiasis in children has risen worldwide over the last decades with geographical varieties. As pediatric patients begin forming stones earlier in life, they have high risk of recurrence. Extracorporeal shockwave lithotripsy (SWL) is a non-invasive treatment modality that is preferred in the management of pediatric stones. Reports about the safety and efficacy of SWL in patients younger than 24 months are scarce in the literature. OBJECTIVE The aim of the study was to evaluate the effectiveness and safety of SWL in patients younger than 24 months. The authors also aimed to assess the validity of the Dogan nomogram in predicting stone-free rates. STUDY DESIGN Between January 2009 and March 2019, data of 247 patients younger than 24 months at the time of SWL were retrospectively collected. Analysis was performed on 260 renal units. Success was considered in patients who were completely free of stones after the first session. RESULTS AND DISCUSSION The female/male ratio was 103/157, with a median age of 15 (5-24) months, a median stone size of 8 (3-30) mm and a median follow-up period of 7 (3-20) months. Multiple stones and lower calyx stones were observed in 19.6% (51/260) and 23.4% (61/260) of patients, respectively. Complications were detected in 5.8% (15/260) of patients (9 with steinstrasse, 3 with UTI, 2 with vomiting, 1 with hematuria). After the first session, 56.9% (148/260) of patients were stone-free. Forty-six of the failed 112 first sessions underwent second session. A total of 5 patients had a third session. The efficacy quotient was 57%. On univariate analysis, younger age (≤16 months), single stone, small stone size (<10 mm), and non-lower pole location were significant predictors of stone clearance. On multivariate analysis, younger age (=<16 months) and single stone remained significant. The Dogan nomogram score lower than 150 was found to be a good cutoff point to predict better stone clearance (Table). CONCLUSION Shockwave lithotripsy is a safe and effective treatment modality in patients younger than 24 months and could be the first option in this particular age-group in whom the other endourological modalities are not always applicable. The Dogan nomogram is reliable in predicting the stone-free rate in this age-group.
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Affiliation(s)
- Tariq Asi
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
| | - Hasan Serkan Dogan
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Mesut Altan
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ali Cansu Bozaci
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Taner Ceylan
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ahmet Asci
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Serdar Tekgul
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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Abstract
PURPOSE OF REVIEW The purpose of this review is to describe the options and recent developments in the urologic treatment of nephrolithiasis in children. The prevalence of nephrolithiasis in children has increased over time. The urologic treatment of nephrolithiasis ranges from observation to medical expulsive therapy with an alpha blocker for a stone in a ureter to a variety of procedures for stone removal. RECENT FINDINGS Observation for small, asymptomatic renal stones is a reasonable strategy in children. Medical expulsive therapy with an alpha blocker may have a beneficial effect for passage of ureteral stones in children. Extracorporeal shock wave lithotripsy (ESWL) remains an important treatment for nephrolithiasis in children. Advances in ureteroscopy with clearer digital imaging and single use ureteroscopes have made ureteroscopy more attractive. Percutaneous nephrolithotomy is a more invasive treatment modality but remains a good choice for children with large-stone burdens and instruments are getting smaller. Open or laparoscopic stone surgery should be reserved for unique cases. SUMMARY Nephrolithiasis is increasing in children with differing urologic management options depending on the clinical scenario. A shared decision-making process with discussion of risks and benefits should be used to help patients and families choose a treatment option.
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Destro F, Selvaggio GGO, Lima M, Riccipetitoni G, Klersy C, Di Salvo N, Marinoni F, Calcaterra V, Pelizzo G. Minimally Invasive Approaches in Pediatric Urolithiasis. The Experience of Two Italian Centers of Pediatric Surgery. Front Pediatr 2020; 8:377. [PMID: 32793523 PMCID: PMC7393988 DOI: 10.3389/fped.2020.00377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/04/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Over the last 30 years, the incidence of pediatric urolithiasis (PU) has been increasing and the surgical management has evolved toward a minimally invasive approach (MIA). We reported the experience of two Centers of Pediatric Surgery in the management of PU, focusing on MIA as first choice in treatment. Methods: Data were retrospectively analyzed from October 2009 to October 2019 in children with urolithiasis who were admitted to two referral Italian Centers of Pediatric Surgery. Demographic and clinical data of the patients, features of the urolithiasis, type of surgery were considered. Results: Seventy patients (7.3 ± 5.0 years) with normal renal function were treated for calculi in the pyelocaliceal system (45.7%), ureter (34.3%), bladder (4.3%), urethra (1.4%), and multiple locations (14.3%). Size of calculi was >10 mm in 55.7% of cases (kidney>bladder/urethra>multiple>ureter, p = 0.01). Symptoms were present in 75.7% of patients. Family history was positive in 16.9% of cases. MIA was performed in 59 patients (84.3%): 11.8% shockwave lithotripsy (kidney>ureter>multiple); 32.2% ureteral retrograde surgery (ureteral>other localizations); 30.5% retrograde intrarenal surgery (kidney>other localizations); and 25.4% other procedures including percutaneous nephrolithotomy, cystoscopic bladder stone removal or laser cystolithotripsy (kidney>bladder>multiple). Preoperative stenting was necessary in 52.8% of cases. Four MIA procedures (6.9%, kidney>ureter/multiple) were converted to open surgery. Open surgery was required as first approach in 15.7% of patients (kidney>ureter>multiple) who needed urgent surgery or had associated congenital renal anomalies. In 18/70 of children (25.7%), with prevalence of stones in kidney and multiple location (p < 0.01), a second procedure completed the treatment (88.8% MIA). Intraoperative difficulties were recorded in 8.5% of cases, without difference between location and size of calculi. Late complications (5.7%) were related to displacement and infection of the ureteral stent. Conclusions: MIA resulted to be feasible in more than 75% of primary surgery and in more than 85% of cases requiring a second procedure. Preoperative stent was mandatory in more than 50% of children. The technological evolution allowed to overcome many of the technical difficulties related to the approach to the papilla and lower calyxes. Open surgery is reserved for selected cases and endoscopic surgery represents the best choice of treatment for PU.
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Affiliation(s)
- Francesca Destro
- Pediatric Surgery Unit, V. Buzzi Children's Hospital, Milan, Italy
| | | | - Mario Lima
- Pediatric Surgery Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Catherine Klersy
- Clinical Epidemiology & Biometry, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Neil Di Salvo
- Pediatric Surgery Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy.,Pediatric Unit, V. Buzzi Children's Hospital, Milan, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Unit, V. Buzzi Children's Hospital, Milan, Italy.,Department of Biomedical and Clinical Science L. Sacco, University of Milan, Milan, Italy
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Esposito C, Autorino G, Masieri L, Castagnetti M, Del Conte F, Coppola V, Cerulo M, Crocetto F, Escolino M. Minimally Invasive Management of Bladder Stones in Children. Front Pediatr 2020; 8:618756. [PMID: 33575232 PMCID: PMC7870782 DOI: 10.3389/fped.2020.618756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/15/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Bladder stones (BS) are rare in children. Minimally invasive surgery (MIS) seems to be nowadays the procedure of choice to treat pediatric patients with BS. This study aimed to analyze retrospectively our experience with percutaneous cystolithotomy, endourological treatment with Holmium laser and robotic cystolithotomy in children with BS. Methods: We retrospectively analyzed the data of 13 children (eight boys and five girls) with BS who were treated at our centers between July 2013 and July 2020. The patients received three different MIS procedures for stones removal: five underwent robotic cystolithotomy, five underwent endourological treatment and three received percutaneous cystolithotomy (PCCL). We preferentially adopted endourological approach for stones <10 mm, percutaneous approach between 2014 and 2016 and robotic approach since 2016 for larger stones. Results: Mean patients' age at the time of diagnosis was 13 years (range 5-18). Ten/13 patients (76.9%) had primary BS and 3/13 patients (23.1%) had secondary BS. Mean stone size was 18.8 mm (range 7-50). In all cases the stones were removed successfully. One Clavien II post-operative complication occurred following PCCL (33.3%). All the procedures were completed without conversions. Operative time ranged between 40 and 90 min (mean 66) with no significant difference between the three methods (p = 0.8). Indwelling bladder catheter duration was significantly longer after PCCL (mean 72 h) compared with robotic and endourological approaches (mean 15.6 h) (p = 0.001). Hospitalization was significantly longer after PCCL (mean 7.6 days) compared with the other two approaches (mean 4.7 days) (p = 0.001). The endourological approach was the most cost-effective method compared with the other two approaches (p = 0.001). Conclusions: Minimally invasive management of bladder stones in children was safe and effective. Endourological management was the most cost-effective method, allowing a shorter hospital stay compared with the other procedures but it was mainly indicated for smaller stones with a diameter < 10 mm. Based upon our preliminary results, robotic surgery seemed to be a feasible treatment option for BS larger than 15-20 mm. It allowed to remove the big stones without crushing them with a safe and easy closure of the bladder wall thanks to the easy suturing provided by the Robot technology.
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Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Giuseppe Autorino
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Lorenzo Masieri
- Pediatric Urology Unit, Meyer Children Hospital, Florence, Italy
| | | | - Fulvia Del Conte
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Vincenzo Coppola
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Mariapina Cerulo
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Felice Crocetto
- Urology Unit, Federico II University of Naples, Naples, Italy
| | - Maria Escolino
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
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