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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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Cobellis G, Bindi E. Pyeloplasty in Children with Ureteropelvic Junction Obstruction and Associated Kidney Anomalies: Can a Robotic Approach Make Surgery Easier? CHILDREN (BASEL, SWITZERLAND) 2023; 10:1448. [PMID: 37761409 PMCID: PMC10527626 DOI: 10.3390/children10091448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Robot-assisted pyeloplasty is widely used in pediatric surgery because of its well-known advantages over open or laparoscopic surgery. The aim is to explore our experience and evaluate the achievements we have made. METHODS We evaluated patients undergoing robotic pyeloplasty from January 2016 to November 2021, including those who presented with a ureteropelvic junction obstruction associated with other anomalies of the kidney. The parameters examined were: age, weight, associated renal malformations, conversion rate, operative time, and intra- and postoperative complications. RESULTS Of 39 patients, 7 (20%) were included, of whom 5 (71%) were male and 2 (29%) were female. The mean age at surgery was 84 months (range 36-180 months), and the mean weight at surgery was 24.4 kg (range 11-40 kg). In five (71%) patients the ureteropelvic junction obstruction (UPJO) was left-sided and in two (29%) it was right-sided. In four (57%) cases, UPJO was associated with a horseshoe kidney, right-sided in one (25%) patient, and left-sided in the other three (75%). A 180° rotation of the kidney was present in one (14%) patient. Nephrolithiasis was present in two (29%) patients. The mean operative time was 160 min (range 140-240 min). The average bladder catheter dwell time was 1 day (range 2-3 days), while the average abdominal drainage dwell time was 2 days (range 2-4 days). The mean hospitalization time was 4 days (range 3-9 days). On average, after 45 days (range 30-65) the JJ ureteral stent was removed cystoscopically. No intraoperative complications were reported, while one case of persistent macrohematuria with anemia requiring blood transfusion occurred postoperatively. CONCLUSIONS Ureteropelvic junction obstruction might be associated with other congenital urinary tract anomalies such as a duplicated collecting system, horseshoe kidney, or pelvic kidney. These kinds of malformations can complicate surgery and require more attention and accuracy from the surgeon. Our experience shows that, with regards to the robotic learning curve required for pyeloplasty, the treatment of the ureteropelvic junction in these situations does not present insurmountable difficulties nor is burdened by complications. The application of robot-assisted surgery in pediatric urology makes difficult pyeloplasties easier.
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Affiliation(s)
- Giovanni Cobellis
- Pediatric Surgery Unit, Salesi Children’s Hospital, Via F. Corridoni 11, 60123 Ancona, Italy;
- Department of Pediatric Surgery, Università Politecnica of Marche, 60121 Ancona, Italy
| | - Edoardo Bindi
- Pediatric Surgery Unit, Salesi Children’s Hospital, Via F. Corridoni 11, 60123 Ancona, Italy;
- Department of Pediatric Surgery, Università Politecnica of Marche, 60121 Ancona, Italy
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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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Robot-Assisted versus Trans-Umbilical Multiport Laparoscopic Ureteral Reimplantation for Pediatric Benign Distal Ureteral Stricture: Mid-Term Results at a Single Center. J Clin Med 2022; 11:jcm11216229. [PMID: 36362458 PMCID: PMC9656945 DOI: 10.3390/jcm11216229] [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: 08/09/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022] Open
Abstract
Objective: Robot-assisted laparoscopic ureteral reimplantation (RALUR) and trans-umbilical multiport laparoscopic ureteral reimplantation (TMLUR) are both minimally invasive procedures for benign distal ureteral stricture (DUS). However, TMLUR has rarely been reported in published research, thus the difference in mid-term outcome of these two procedures warrants investigation. Methods: Patients who underwent RALUR or TMLUR for pediatric DUS from April 2017 to November 2020 at our institution were retrospectively analyzed and 56 patients were included in this retrospective comparison. Demographic characteristics, perioperative data and follow-up results were collected and analyzed in RALUR and TALUR groups. Results: RALUR and TMLUR were successfully performed in children aged from 12.0 to 142.0 months, without conversion to open ureteral reimplantation. RALUR took shorter operative time than TMLUR (p = 0.005) with less blood loss (p = 0.001). Meanwhile, patients receiving RALUR encountered a greater financial burden (p < 0.001) with less cosmetic satisfaction than TMLUR. The mean mid-term follow-up time for RALUR and TMLUR was 18.29 months and 24.64 months, respectively. Mid-term follow-up data showed that DUS was relieved with improved renal function after surgery in both groups, with no significant difference. Conclusions: RALUR and TMLUR are both safe and efficient for DUS treatment and achieve comparable mid-term outcomes in children. RALUR can reduce operative time and operative blood loss benefiting from its prominent technical superiority, but may currently bring about greater financial burden, with cosmetic satisfaction remaining to be improved.
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