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Utangaç MM, Dede O. Evaluation of the Largest Series of Ultramini Percutaneous Nephrolithotomy in Preschool Children: 10-Year Experience with 711 Units of Kidney Stones. J Clin Med 2025; 14:3355. [PMID: 40429350 DOI: 10.3390/jcm14103355] [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: 04/07/2025] [Revised: 04/30/2025] [Accepted: 05/08/2025] [Indexed: 05/29/2025] Open
Abstract
Background and Objectives: This study aimed to evaluate the safety, efficacy and outcomes of ultramini percutaneous nephrolithotomy (UM-PNL) in preschool-aged children with kidney stones. Materials and Methods: A retrospective analysis was conducted on 711 renal units of 676 paediatric patients aged 0-6 years who underwent UM-PNL between April 2014 and July 2024. The children's demographic data, stone characteristics, operative details and postoperative outcomes were analysed. The procedure was performed using a 9.5 Fr sheath and a 7.5 Fr nephroscope, with laser lithotripsy applied. Postoperative follow-up included imaging and a clinical assessment of complications. Results: The mean patient age was 34.2 months (range: 5-72 months). Haematuria (36.8%) and urinary tract infections (24.5%) were the most common presenting symptoms. The mean stone size was 16.2 mm, and the stone-free rate was 89.2% after the first session, increasing to 96.4% with additional interventions. The mean operative time was 38 min. No major complications were observed; 8.4% of cases had Clavien grade 3b complications, most of which were managed conservatively. Blood transfusion was required in 2.6% of the cases. Conclusions: UM-PNL is a safe and effective treatment method for kidney stones in preschool-aged children, characterized by high stone-free rates and a low risk of complications. With proper patient selection and experienced surgical teams, UM-PNL can be considered a first-line option in paediatric stone management.
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Affiliation(s)
- Mehmet Mazhar Utangaç
- Department of Urology, Faculty of Medicine, Dicle University, 21280 Diyarbakir, Turkey
| | - Onur Dede
- Department of Urology, Faculty of Medicine, Dicle University, 21280 Diyarbakir, Turkey
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Quiroz Madarriaga Y, Dönmez Mİ, Lammers RJM, Marco BB, Baydilli N, Bindi E, Sforza S, Hoen LA'. Present Insights and Future Perspectives in Pediatric Percutaneous Nephrolithotomy: A Systematic Review by the EAU-YAU Pediatric Urology Working Group. J Endourol 2025. [PMID: 40336175 DOI: 10.1089/end.2024.0727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2025] Open
Abstract
Background and Objective: The incidence of stone disease in children has risen worldwide, leading to the development of more treatment options. Percutaneous nephrolithotomy (PCNL) is often the preferred approach in many pediatric cases. This systematic review aims to assess the effectiveness and safety of PCNL in children, as well as to identify future directions for improving procedural outcomes. Methods: For this systematic review a comprehensive electronic search was conducted in PubMed and EMBASE in August 2023. The search included patients younger than 18 with renal stones requiring any modality of PCNL, as well as to establish the deficiencies in the reports of outcomes. The search strategy adhered to PRISMA guidelines, and quality assessments were performed using the Cochrane tool and MINORS tool. Key Findings and Limitations: Regardless of age, PCNL is safe and efficient in children, with stone-free rate above 85% and complication rate below 7%. However, neither the definition of stone free nor the way of reporting complications is homogeneous among studies. In addition, aspects such as diagnostic imaging, antibiotic prophylaxis, postoperative drainage, metabolic study, or follow-up are not systematically or uniformly reported in the studies. Conclusions and Clinical Implications: PCNL maintains its efficiency and safety even when the working tract caliber is reduced. However, the lack of standardization when describing pre-, peri-, and postoperative aspects creates a gap that does not allow grouping outcomes and highlights the lack of clear guidelines when implementing this surgical procedure.
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Affiliation(s)
| | - Muhammet İrfan Dönmez
- Division of Pediatric Urology, Department of Urology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Rianne J M Lammers
- Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Numan Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Edoardo Bindi
- Department of Pediatric Surgery, AOU Delle Marche, Ospedale Pediatrico G Salesi, Ancona, Italy
| | - Simone Sforza
- Department of Pediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
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Fang H, Wang Z, Wei K, Liu X, Wu S, Hua Y, Lin T, He D, Wei G, Zhang D. Safety and efficacy of standard vs. tubeless percutaneous nephrolithotomy in pediatric populations: an updated systematic review and meta-analysis. BMC Urol 2025; 25:110. [PMID: 40316976 PMCID: PMC12049033 DOI: 10.1186/s12894-025-01798-4] [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: 01/04/2025] [Accepted: 04/22/2025] [Indexed: 05/04/2025] Open
Abstract
OBJECTIVE This study aims to compare the safety and efficacy of standard versus tubeless percutaneous nephrolithotomy (PCNL) in pediatric populations. METHODS A systematic search was conducted in the Web of Science, Cochrane Library, PubMed, and Embase databases to identify studies that met the inclusion criteria. Two authors independently screened the literature and extracted data. A meta-analysis was performed using RevMan 5.4 software. This study has been prospectively registered with PROSPERO (ID: CRD42024622238). Sensitivity analysis was performed using Stata 17.0 to assess the impact of low-quality studies, and publication bias was evaluated using funnel plots. RESULTS A total of 3 randomized controlled trials and 10 case-control studies were included, comprising 661 cases. The meta-analysis revealed that, in pediatric populations, the tubeless PCNL group had significantly shorter hospital stays compared to the standard PCNL group (WMD = -1.60, 95% CI: -2.27 to -0.92, P < 0.01), as well as shorter operative times (WMD = -2.06, 95% CI: -4.02 to -0.10, P = 0.04). The stone clearance rate was higher in the tubeless PCNL group than in the standard group (OR = 2.18, 95% CI: 1.09 to 4.34, P = 0.03). Additionally, the tubeless PCNL group had lower rates of postoperative fever (OR = 0.46, 95% CI: 0.27 to 0.78, P < 0.01) and postoperative urine leakage (OR = 0.20, 95% CI: 0.08 to 0.50, P < 0.01) compared to the standard group. The tubeless PCNL group also had shorter pain management times (WMD = -2.00, 95% CI: -2.44 to -1.56, P < 0.01) and lower visual analog scale (VAS) scores (WMD = -2.52, 95% CI: -2.81 to -2.22, P < 0.01). However, no significant differences were observed between the two groups in terms of hemoglobin decline, overall complications (including perinephric fluid collections, urinary tract infections, and blood transfusion requirements), and reoperation rates. CONCLUSION In children with kidney stones and low stone burden or an uneventful procedure, tubeless PCNL offers clear clinical advantages, including shorter hospital stays, higher stone clearance rates, and lower postoperative fever. Additionally, it improves surgical efficiency, reduces postoperative complications, and decreases the need for analgesia. These benefits suggest that tubeless PCNL can be safely applied in pediatric patients, yielding outcomes comparable to standard PCNL, provided that indications are properly managed". CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Honggang Fang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Zihan Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Kuan Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Xing Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Shengde Wu
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Yi Hua
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Dawei He
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Guanghui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Deying Zhang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
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Hong Y, Yu L, Huang X, An L, Xiong L, Xu T, Xu Q. Outcome of Ultrasonography-Guided Percutaneous Nephrolithotomy for the Management of Pediatric Urolithiasis. J Endourol 2025; 39:146-150. [PMID: 39535858 DOI: 10.1089/end.2023.0771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024] Open
Abstract
Objectives: This study aims to assess the outcomes of ultrasonography (US)-guided minimally invasive percutaneous nephrolithotomy (PCNL) in the treatment of pediatric urolithiasis. Methods: A retrospective analysis was conducted on 176 patients with pediatric renal and upper ureteral lithotripsy who underwent PCNL between August 2006 and July 2022. The cohort comprised 110 men and 66 women, with ages ranging from 6 months to 16 years. Postoperative stone clearance was evaluated using kidney, ureter, and bladder radiograph or US, categorizing stones less than 4 mm as clear. Postoperative complications were graded according to the Clavien-Dindo classification, with grades I and II considered minor and III and IV classified as major. Results: Among the patients, 152 underwent unilateral renal operation, whereas 24 underwent bilateral renal operation. The average operation duration was 67.41 minutes (range: 15-195 minutes). The mean duration of nephrostomy tube removal was 3.79 days, and the mean postsurgical hospital stay was 5.97 days. A total of 146 patients experienced a decrease in hemoglobin concentration post operation, with an average drop of 10.57 g/dL (range: 0.5-37.8 g/dL). Initial stone-free rate (SFR) was achieved in 85.5% (171/200) of cases, and the final SFR was 92.50% (185/200). The postoperative rate of minor complications was 8.54% (17/199), whereas major complications occurred in 12.06% (24/199) of cases. During the 6-month to 11-year follow-up period, 19 patients presented with combined stones, and of these 4 presented with ipsilateral stone recurrence who underwent PCNL treatment. Calcium oxalate was identified as the most common stone component. Conclusions: US-guided minimally invasive PCNL demonstrated excellent SFR and an acceptable complication rate in the management of pediatric urolithiasis. Furthermore, it offers the advantage of minimizing potential risks associated with radiation exposure during the procedure.
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Affiliation(s)
- Yang Hong
- Department of Urology, Peking University People's Hospital, Beijing, China
- Peking University Applied Lithotripsy technology Institute, Beijing, China
| | - Luping Yu
- Department of Urology, Peking University People's Hospital, Beijing, China
- Peking University Applied Lithotripsy technology Institute, Beijing, China
| | - Xiaobo Huang
- Department of Urology, Peking University People's Hospital, Beijing, China
- Peking University Applied Lithotripsy technology Institute, Beijing, China
| | - Lizhe An
- Department of Urology, Peking University People's Hospital, Beijing, China
- Peking University Applied Lithotripsy technology Institute, Beijing, China
| | - Liulin Xiong
- Department of Urology, Peking University People's Hospital, Beijing, China
- Peking University Applied Lithotripsy technology Institute, Beijing, China
| | - Tao Xu
- Department of Urology, Peking University People's Hospital, Beijing, China
- Peking University Applied Lithotripsy technology Institute, Beijing, China
| | - QingQuan Xu
- Department of Urology, Peking University People's Hospital, Beijing, China
- Peking University Applied Lithotripsy technology Institute, Beijing, China
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Li C, Zhao Y, Wang W, Li J, Tian Y, Ning C. Comparison between Micro-(4.85Fr) and Ultramini-(<15Fr) percutaneous nephrolithotomy for the treatment of 10-20 mm kidney stones in preschool children. J Pediatr Urol 2024:S1477-5131(24)00680-6. [PMID: 39779432 DOI: 10.1016/j.jpurol.2024.12.018] [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: 07/18/2024] [Revised: 12/17/2024] [Accepted: 12/22/2024] [Indexed: 01/11/2025]
Abstract
INTRODUCTION The incidence of kidney stones in children has steadily increased in recent years. Miniaturized percutaneous nephrolithotomy (PCNL) techniques, such as micro-PCNL(4.85Fr) and ultramini-PCNL(<15Fr), have become increasingly prevalent in pediatric kidney stone treatment due to their high stone clearance rate and low complication rate. This study aimed to compare the efficacy and safety of micro-PCNL and ultramini-PCNL in preschool children with 10-20 mm kidney stones. PATIENTS AND METHODS A retrospective analysis was performed on data from patients under 6 years who received micro-PCNL and ultramini-PCNL surgeries in our hospital between January 2020 and January 2024. The inclusion criteria consisted of pediatric patients (<6 years) with unilateral 10-20 mm kidney stones. Patients with urinary tract malformations or comorbidities were excluded from the study. Patient demographics, stone characteristics, and intra- and postoperative parameters were analyzed. RESULTS There were 33 patients in the micro-PCNL group and 31 patients in the ultramini-PCNL group, with a mean age of 3.1 ± 1.3 years and 3.6 ± 1.8 years (p = 0.208), respectively. The stone size was 15 ± 4 mm in the micro-PCNL group and 16 ± 4 mm in the ultramini-PCNL group (p = 0.326). Micro-PCNL and ultramini-PCNL groups showed comparable stone-free rates (84.8 % vs. 87.1 %, p = 0.796) and procedure times (49 ± 17 min vs. 54 ± 23 min, p = 0.218). However, a significantly shorter hospitalization period was observed in the micro-PCNL group compared with the ultramini-PCNL group (2.3 ± 1.3 days vs. 4.6 ± 2.2 days, p < 0.001). Complications were similar between groups, with 12.4 % in the micro-PCNL group and 16.1 % in the ultramini-PCNL group and no severe hematuria was observed. CONCLUSIONS In preschool children with 10-20 mm kidney stones, both micro-PCNL and ultramini-PCNL achieve similarly high stone-free rates with minimal complications, showing comparable outcomes in appropriately selected patients with experienced surgeons.
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Affiliation(s)
- Chenglong Li
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China; Institute of Urology, Beijing Municipal Health Commission, Beijing, 100050, China
| | - Youquan Zhao
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China; Institute of Urology, Beijing Municipal Health Commission, Beijing, 100050, China
| | - Wenying Wang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China; Institute of Urology, Beijing Municipal Health Commission, Beijing, 100050, China
| | - Jun Li
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China; Institute of Urology, Beijing Municipal Health Commission, Beijing, 100050, China
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China; Institute of Urology, Beijing Municipal Health Commission, Beijing, 100050, China.
| | - Chen Ning
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China; Institute of Urology, Beijing Municipal Health Commission, Beijing, 100050, China.
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Abuelnaga M, Esmat M, Hatata AN, Samir YR, Arafa H, Salem MS. Clinical efficacy of mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the management of upper urinary tract calculus (1-2.5 cm) in children ≤10 years of age. J Pediatr Urol 2024; 20:605.e1-605.e8. [PMID: 38851968 DOI: 10.1016/j.jpurol.2024.05.019] [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: 11/22/2023] [Revised: 05/08/2024] [Accepted: 05/22/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND With improvements in endoscopic surgery, open surgical procedures for urinary system stones have cleared the path for the use of less invasive treatment modalities in patients with pediatric kidney stone disease. Extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS) are among the treatment options available. OBJECTIVE To prospectively evaluate the outcomes of mini-percutaneous nephrolithotomy and retrograde intrarenal surgery (RIRS) for children ≤10 years of age with upper urinary tract calculus (1-2.5 cm). STUDY DESIGN Sixty pediatric patients with single or multiple renal stones (1-2.5 cm in diameter) were collected prospectively and equally divided into two groups to undergo RIRS or mini-PCNL. The operative and postoperative outcomes of both groups were analyzed. RESULTS The groups' mean ages and genders were comparable. The mean stone size for the RIRS group was 1.86 cm and 1.69 cm for the PCNL group (P = 0.449). The PCNL group had statistically longer mean fluoroscopy and hospitalization times. The stone-free rates (SFRs) after a single procedure were 27 (90%) in the PCNL group and 25 (83.33%) in the RIRS group (P = 0.706). The UAS was placed in 13 (43.33%) patients in the RIRS group. In the RIRS group, 14 (46.67%) children required preoperative DJ stent application to passively dilate the ureteric orifice. As regard post DJ stenting, 13 (46%) cases applied DJ in the mini PCNL group. major complications were observed in either group. Minor complication (Clavien 1-3) rates were 16.66% and 13.33% for the PCNL and RIRS groups, respectively. There were no differences found between the RIRS and mini-PCNL groups regarding operative time. The mean cost of RIRS was $703.96 and $537.03 for the mini-PCNL. CONCLUSION According to the results of this study, mini-PCNL and RIRS are effective procedures for treating renal stones in children up to 2.5 cm with comparable success and complication rates. Hospital stay, radiation exposure, and fluoroscopy time are significantly lower in RIRS than in the mini PCNL technique. Although RIRS is effective, a major disadvantage is the greater requirement for JJ stent insertion either before or after the procedure and the consequent need for a second procedure for removal.
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Kiani K, Amirhasani S, Mousavi-Bahar SH, Moradi A. A retrospective cohort study: evaluating the efficacy of standard versus tubeless percutaneous nephrolithotomy (PCNL) in pediatric patients up to 18 years old. Urolithiasis 2024; 52:68. [PMID: 38634971 DOI: 10.1007/s00240-024-01540-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/05/2024] [Indexed: 04/19/2024]
Abstract
Percutaneous nephrolithotomy (PCNL) is an endourological method applied as the standard or tubeless method for kidney stone treatment. In a retrospective cohort study, 88 surgery units involving 75 children up to 18 years old with kidney stones who underwent the surgery for 8 years in Shahid Beheshti and Boo-ali hospitals in Hamadan with one of the two methods of standard or tubeless PCNL were evaluated and compared considering the success rate of operation, hemoglobin, hematocrit drop, need for medications, need for blood transfusion, duration of surgery, and the length of hospital stay. Among the 88 units studied, 47 cases were operated with the standard PCNL and 41 cases by tubeless method. In children operated by standard and tubeless PCNL, the complete success rate of operation was 87.2% and 100% (P = 0.006), the need for blood transfusion was 2.1% and 0% (P = 1.00), the need for opioids was 27.7% and 14.6% (P = 0.134), the decrease in hemoglobin was - 1.82 ± 0.94 and -1.30 ± 0.98 mg/dl (P = 0.024), the decrease in hematocrit was - 5.40 ± 2.66 and -3.52 ± 3.11 mg/dL (P = 0.003), the mean surgery duration was 109.30 ± 53.27 and 101.46 ± 31.92 min (P = 0.414), the duration of postoperative hospitalization was 3.38 ± 1.76 and 2.46 ± 1.27 days (P = 0.007), and the frequency of fever was 23.4% and 7.3% (P = 0.04), respectively. The success rate of kidney stone surgery in children with the tubeless PCNL is higher than the standard method, and its complications are lower.
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Affiliation(s)
- Kian Kiani
- Department of Urology, Ilam University of Medical Sciences, Ilam, Iran
- Development Unit, Imam Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
| | - Shahriar Amirhasani
- Urology and Nephrology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Abbas Moradi
- Department of Community Medicine, Hamedan University of Medical Science, Hamadan, Iran
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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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Guideline Adherence of Paediatric Urolithiasis: An EAU Members' Survey and Expert Panel Roundtable Discussion. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040504. [PMID: 35455549 PMCID: PMC9030251 DOI: 10.3390/children9040504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 12/23/2022]
Abstract
Background: Paediatric nephrolithiasis has increased globally, requiring standardized recommendations. This study aims to assess the paediatric urolithiasis care between EAU members along with the statements of three experts in this field. Methods: The results of an electronic survey among EAU members comparing the guideline recommendations to their current practice managing paediatric nephrolithiasis in 74 centres are contrasted with insights from an expert-panel. The survey consisted of 20 questions in four main sections: demographics, instrument availability, surgical preferences and follow-up preferences. Experts were asked to give insights on the same topics. Results: A total of 74 responses were received. Computerised Tomography was predominantly used as the main imaging modality over ultrasound. Lack of gonadal protection during operations was identified as an issue. Adult instruments were used frequently instead of paediatric instruments. Stone and metabolic analysis were performed by 83% and 63% of the respondents respectively. Conclusions: Percutaneous Nephrolithotomy is the recommended standard treatment for stones > 20 mm, 12% of respondents were still performing shockwave lithotripsy despite PNL, mini and micro-PNL being available. Children have a high risk for recurrence yet stone and metabolic analysis was not performed in all patients. Expert recommendations may guide clinicians towards best practice.
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Is Mini Percutaneous Nephrolithotomy a Game Changer for the Treatment of Renal Stones in Children? EUR UROL SUPPL 2022; 37:45-49. [PMID: 35243389 PMCID: PMC8883193 DOI: 10.1016/j.euros.2021.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 12/01/2022] Open
Abstract
Background Mini percutaneous nephrolithotomy (MPCNL) is a newer surgical procedure that has changed the management of paediatric renal stones. Objective To evaluate MPCNL morbidity and success rates for renal stones as a function of patient age in a paediatric cohort. Design, setting, and participants This was a retrospective case series that included 143 consecutive patients younger than 17 yr who underwent MPCNL at our institution between January 2016 and November 2020. The patients were categorised into three different age groups: <6 yr (n = 71, 49.7%), 6–11 yr (n = 44, 30.8%), and 12–17 yr (n = 28, 19.6%). MPCNL was performed in all patients through 16–20Fr tracts. Outcome measurements and statistical analysis The stone-free rate, perioperative complications, tract number, operative time, postoperative haemoglobin change, and hospitalisation time were evaluated for each age group. Results and limitations MPCNL was performed in 143 paediatric patients (88 boys and 55 girls; mean age 6.53 yr). The mean stone burden (± standard deviation) was 2.096 ± 1.01 cm in group one, 2.05 ± 1.05 cm in group two, and 3.46 ± 19.94 cm in group three; group three was significantly larger (p = 0.001). After a single MPCNL session, 92.42% of patients experienced complete stone clearance. All age groups were similar in terms of stone-free rate (p = 0.82), hospitalisation time (p = 0.94), postoperative haemoglobin change (p = 0.06), and perioperative complications (p = 0.62). However, stone size (p = 0.009), stone complexity (p = 0.001), number of access points (p = 0.03), and operative time (p = 0.009) were higher in the group aged 12–17 yr. Conclusions MPCNL is an effective and safe procedure in younger as well as older children. Age should not be considered a limiting factor for MPCNL in children, and MPCNL should be considered the primary option for treating paediatric renal stones when PCNL is indicated. Patient summary Our results show that surgical removal of kidney stones through an incision in the skin and using miniaturised instruments is an effective and safe procedure for children.
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Mahmoud MA, Shawki AS, Abdallah HM, Mostafa D, Elawady H, Samir M. Use of retrograde intrarenal surgery (RIRS) compared with mini-percutaneous nephrolithotomy (mini-PCNL) in pediatric kidney stones. World J Urol 2022; 40:3083-3089. [PMID: 36244014 PMCID: PMC9712365 DOI: 10.1007/s00345-022-04186-x] [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: 08/26/2022] [Accepted: 10/05/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE We aimed to compare the cost-effectiveness and safety of retrograde intrarenal surgery (RIRS) and mini-percutaneous nephrolithotomy (mini-PCNL) for pediatric kidney stones management. PATIENTS AND METHODS Ninety pediatric patients with single or multiple renal stones 1-3 cm in diameter were collected prospectively and equally divided into two groups to undergo RIRS or mini-PCNL. The groups were compared for fluoroscopy and operative time, postoperative hospital stay time, stone-free rate (SFR), need for auxiliary procedures, and cost as well as complications. RESULTS There were no differences found between RIRS and mini-PCNL groups with regard to operative time and postoperative DJ stent application, while the mean of fluoroscopy time and postoperative hospital stay was significantly shorter in the RIRS than in the mini-PCNL group. The SFR, auxiliary treatment on residual stones, and complications were comparable. In both groups, no major (Clavien IV-V) complications were observed. The mean cost of RIRS was $1210 and $733 for the mini-PCNL. CONCLUSIONS Both RIRS and mini-PCNL are effective and safe treatment modalities for pediatric renal stones 10-30 mm in size. However, mini-PCNL is more cost-effective making it a viable alternative to RIRS.
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12
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Kahraman O, Dogan HS, Asci A, Asi T, Haberal HB, Tekgul S. Factors associated with the stone-free status after retrograde intrarenal surgery in children. Int J Clin Pract 2021; 75:e14667. [PMID: 34320260 DOI: 10.1111/ijcp.14667] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Paediatric urolithiasis has a recurrent nature because it is frequently associated with metabolic or anatomical disorders or infectious conditions. The rising incidence of the disease with its recurrent nature emphasises the need for minimally invasive therapeutic options. In this study, we aimed to evaluate efficacy and factors affecting the success of retrograde intrarenal surgery (RIRS) in children. MATERIALS AND METHODS Patients who underwent RIRS were evaluated retrospectively. Two different flexible ureteroscopes (F-URS) were used (7.5F F-URS and 7.95F with a 4.9F bullet-shaped tip). Irrespective of size, all residual fragments were considered as failure. Age, stone size, stone localisation, Hounsfield Unit (HU), stone-free rate (SFR) and complications were evaluated. RESULTS Forty-six patients (29 boys and 17 girls) with a median age of 70.5 months (6-214 months) were treated with RIRS between August 2014 and November 2019. The median operative time was 60 minutes (45-120 minutes). The median follow-up was 26 months (3-65 months). Fourteen patients had lower pole and 10 patients had multiple stones. Ureteral access sheath (UAS) was used in 16 (35%) patients. SFR was 61%. The median number of general anaesthesia was 2 (min 1, max 5). Auxiliary semirigid URS, PCNL and repeat RIRS were required in 4, 6 and 5 patients, respectively. Two patients had postoperative febrile urinary tract infection (UTI) as a complication. Age was associated with post-operative febrile UTI. Presence of stones with HU lower than 700, being operated 4.9F F-URS and without UAS were associated with better SFR. CONCLUSIONS RIRS is a minimally invasive method with low complication rates in the treatment of childhood stone disease. Higher stone-free rates are obtained in low HU stones and cases in which we used 4.9 F tip F-URS.
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Affiliation(s)
- Oguzhan Kahraman
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hasan Serkan Dogan
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ahmet Asci
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tariq Asi
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Serdar Tekgul
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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13
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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: 1.0] [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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14
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Yıldızhan M, Asil E. Tubeless PNL can safely be applied to selected patients in pediatric stone disease. Turk J Urol 2020; 47:164-169. [PMID: 33085603 DOI: 10.5152/tud.2020.20066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/21/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the results of tubeless percutaneous nephrolithotomy (TPNL) and standard percutaneous nephrolithotomy (SPNL) for the management of nephrolithiasis in children. MATERIAL AND METHODS The data for 48 patients aged lesser than 18 years who underwent percutaneous nephrolithotomy (PNL) between January 2010 and June 2018 were reviewed retrospectively. The patients were classified into 2 categories depending on tube placement. A total of 21 patients were treated with TPNL and 27 with SPNL technique. The surgical method employed was selected depending on intraoperative complications. The size of the endoscopic instrument (mini/standard) to be used was decided according to the stone burden and surgeon preference. RESULTS A complete stone-free rate (SFR) was achieved in 85.7% (n=18) of the TPNL group and 85.2% (n=23) of the SPNL group (p=0.959). In the TPNL group, two patients with clinically significant stones underwent retrograde intrarenal surgery, and one patient with clinically insignificant residual stone remained under follow-up. In the SPNL group, two patients with clinically significant stones underwent repeat mini-PNL surgery, the stones being fragmented with shock wave lithotripsy in one patient, and 1 one patient with insignificant residual stone remained under follow-up. No significant differences were observed in terms of intraoperative and postoperative complications, mean SFRs, or operative and fluoroscopy times. However, a statistically significant difference was observed in lengths of hospital stay (p<0.001). CONCLUSION TPNL is a safe and effective procedure in children. No significant difference was found between TPNL and SPNL in terms of stone clearance; however, patients undergoing TPNL had significantly shorter hospital stays.
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Affiliation(s)
| | - Erem Asil
- Department of Urology, Ankara City Hospital, Ankara, Turkey
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15
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Imaging modalities and treatment of paediatric upper tract urolithiasis: A systematic review and update on behalf of the EAU urolithiasis guidelines panel. J Pediatr Urol 2020; 16:612-624. [PMID: 32739360 DOI: 10.1016/j.jpurol.2020.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prompt diagnosis and treatment of paediatric urolithiasis are required to avoid long term sequelae of renal damage. OBJECTIVE To systematically review the literature regarding the diagnostic imaging modalities and treatment approaches for paediatric urolithiasis. STUDY DESIGN PubMed, Science Direct, Scopus and Web of Science were systematically searched from January 1980-January 2019. 76 full-text articles were included. RESULTS Ultrasound and Kidney-Ureter-Bladder radiography are the baseline diagnostic examinations. Non-contrast Computed Tomography (CT) is the second line choice with high sensitivity (97-100%) and specificity (96-100%). Magnetic Resonance Urography accounts only for 2% of pediatric stone imaging studies. Expectant management for single, asymptomatic lower pole renal stones is an acceptable initial approach, especially in patients with non-struvite, non-cystine stones<7 mm. Limited studies exist on medical expulsive therapy as off-label treatment. Extracorporeal shock wave lithotripsy (SWL) is the first-line treatment with overall stone free rates (SFRs) of 70-90%, retreatment rates 4-50% and complication rates up to 15%. Semi-rigid ureteroscopy is effective with SFRs of 81-98%, re-treatment rates of 6.3-10% and complication rates of 1.9-23%. Flexible ureteroscopy has shown SFRs of 76-100%, retreatment rates of 0-19% and complication rates of 0-28%. SFRs after first and second-look percutaneous nephrolithotomy (PNL) are 70.1-97.3% and 84.6-97.5%, respectively with an overall complication rate of 20%. Open surgery is seldom used, while laparoscopy is effective for stones refractory to SWL and PNL. Limited data exist for robot-assisted management. CONCLUSIONS In the initial assessment of paediatric urolithiasis, US is recommended as first imaging modality, while non-contrast CT is the second option. SWL is recommended as first line treatment for renal stones <20 mm and for ureteral stones<10 mm. Ureteroscopy is a feasible alternative both for ureteral stones not amenable to SWL as well as for renal stones <20 mm (using flexible). PNL is recommended for renal stones >20 mm.
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16
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Haberal HB, Dogan HS, Citamak B, Hazir B, Altan M, Bilen CY, Tekgul S. Outcomes of Percutaneous Nephrolithotomy in Preschool Age Group: A Single-Center Study. J Endourol 2020; 34:1001-1007. [DOI: 10.1089/end.2020.0087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Hasan Serkan Dogan
- Division of Pediatric Urology, Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Burak Citamak
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Berk Hazir
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mesut Altan
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Cenk Yucel Bilen
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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17
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Xiong L, Huang X, Ye X, Chen L, Ma K, Liu J, Hong Y, Xu Q, Wang X. Microultrasonic Probe Combined with Ultrasound-Guided Minipercutaneous Nephrolithotomy in the Treatment of Upper Ureteral and Renal Stones: A Consecutive Cohort Study. J Endourol 2020; 34:429-433. [PMID: 31952455 DOI: 10.1089/end.2019.0639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objectives: We conduct a study to assess the outcome of microultrasonic probe combined with ultrasound (US)-guided minipercutaneous nephrolithotomy (PCNL) for upper ureteral and renal stones. Patients and Methods: Data of 119 patients (123 kidney units) who underwent microultrasonic lithotripsy combined with mini-PCNL were retrospectively reviewed. The group included 96 men and 23 women. All procedure of puncture and dilatation were guided by US solely. Data were analyzed by SPSS. Results: The mean operation time was 32.6 minutes (range, 10-110 minutes). The mean time of lithotripsy and stone removal was 14.5 minutes (3-100 minutes). The mean postoperative length of stay was 2.7 days (1-7 days). Besides, stone-free rate (SFR) at discharge was 95.9% (118/123). The mean hemoglobin drop was 11.6 mg/dL (range 1-26 mg/dL). Grades I, II, and IIIa complications were observed in four, one, and one patients, respectively. Subgroup analysis was done to compare the outcomes of 20 mm or less vs 21 mm or more calculi. There was a longer operation duration (40 vs 29 minutes) and lower SFR in the 21 mm or more calculi subgroup. Conclusions: Microultrasonic probe combined with US-guided mini-PCNL is an effective and safe procedure to treat patients with upper ureteral and renal stones with higher SFR but lower complications.
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Affiliation(s)
- LiuLin Xiong
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University Applied Lithotripsy Institute, Beijing, China
| | - XiaoBo Huang
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University Applied Lithotripsy Institute, Beijing, China
| | - XiongJun Ye
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University Applied Lithotripsy Institute, Beijing, China
| | - Liang Chen
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University Applied Lithotripsy Institute, Beijing, China
| | - Kai Ma
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University Applied Lithotripsy Institute, Beijing, China
| | - Jun Liu
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University Applied Lithotripsy Institute, Beijing, China
| | - Yang Hong
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University Applied Lithotripsy Institute, Beijing, China
| | - QingQuan Xu
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University Applied Lithotripsy Institute, Beijing, China
| | - Xiaofeng Wang
- Department of Urology, Peking University International Hospital, Beijing, China
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18
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Marra G, Taroni F, Berrettini A, Montanari E, Manzoni G, Montini G. Pediatric nephrolithiasis: a systematic approach from diagnosis to treatment. J Nephrol 2018; 32:199-210. [DOI: 10.1007/s40620-018-0487-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/21/2017] [Indexed: 01/26/2023]
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19
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Chen Y, Deng T, Duan X, Zhu W, Zeng G. Percutaneous nephrolithotomy versus retrograde intrarenal surgery for pediatric patients with upper urinary stones: a systematic review and meta-analysis. Urolithiasis 2018; 47:189-199. [DOI: 10.1007/s00240-018-1039-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 01/10/2018] [Indexed: 12/29/2022]
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20
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Yuruk E, Tuken M, Gonultas S, Colakerol A, Cakir OO, Binbay M, Sarica K, Muslumanoglu AY. Retrograde intrarenal surgery in the management of pediatric cystine stones. J Pediatr Urol 2017; 13:487.e1-487.e5. [PMID: 28262541 DOI: 10.1016/j.jpurol.2017.01.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 01/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of retrograde intrarenal surgery (RIRS) in the treatment of pediatric cystine stones. STUDY DESIGN Data of the pediatric patients who underwent RIRS for kidney stones were retrospectively evaluated. A total of 14 children with cystine stones managed with RIRS were identified. In addition to the patient demographics and stone characteristics, all retrospectively obtained operative data were evaluated and discussed in detail, with an emphasis on the success and complication rates. RESULTS Mean age of the 14 cases was 10.9 ± 2.2 years (range: 7-15). Mean stone size was 13.6 ± 2.4 mm (range: 10-18) (Summary table). Of these stones, four were located in the renal pelvis, three were in the lower, three were in the middle and the remaining four were located in upper calyx. Ureteral access sheath was used in 12 (85.7%) patients. The double-J ureteral stent was placed pre-operatively in one case and was inserted postoperatively in 12 cases. Mean operation time was 38.2 ± 7.2 min (range: 30-50). Complications were observed in two cases: mild ureteral laceration in the first and fever on the second postoperative day in the second patient. All of the patients were stone free on sonographic evaluation at the 4-week follow-up evaluation. Although potassium citrate treatment was initiated in 11 patients, tiopronin treatment was initiated in four patients for recurrence prophylaxis during long-term follow-up. During a mean follow-up period of 25.7 ± 5.2 months, stone recurrence was noted in one patient. DISCUSSION Treatment of patients with cystine stones is challenging, due to high risk of rapid recurrence in the presence of residual fragments. Besides allowing complete stone clearance in all cases in the current series, RIRS is a highly reproducible method that can be safely performed, even in recurrences. The major limitations of the current study were low number of patients and short follow-up period. CONCLUSION The results clearly indicated that RIRS is a safe treatment modality in the management of pediatric cystine stones.
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Affiliation(s)
- E Yuruk
- Department of Urology, Bagcilar Research and Training Hospital, Istanbul, Turkey.
| | - M Tuken
- Department of Urology, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - S Gonultas
- Department of Urology, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - A Colakerol
- Department of Urology, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - O O Cakir
- Department of Urology, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - M Binbay
- Department of Urology, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - K Sarica
- Department of Urology, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - A Y Muslumanoglu
- Department of Urology, Bagcilar Research and Training Hospital, Istanbul, Turkey
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21
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Jones P, Bennett G, Aboumarzouk OM, Griffin S, Somani BK. Role of Minimally Invasive Percutaneous Nephrolithotomy Techniques—Micro and Ultra-Mini PCNL (<15F) in the Pediatric Population: A Systematic Review. J Endourol 2017; 31:816-824. [DOI: 10.1089/end.2017.0136] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Patrick Jones
- Department of Urology, Royal Preston Hospital, Preston, United Kingdom
| | - Grace Bennett
- Department of Urology, Royal Preston Hospital, Preston, United Kingdom
| | - Omar M. Aboumarzouk
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Stephen Griffin
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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22
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Silay MS, Ellison JS, Tailly T, Caione P. Update on Urinary Stones in Children: Current and Future Concepts in Surgical Treatment and Shockwave Lithotripsy. Eur Urol Focus 2017; 3:164-171. [DOI: 10.1016/j.euf.2017.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 07/06/2017] [Accepted: 07/18/2017] [Indexed: 01/04/2023]
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23
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Pelit ES, Atis G, Kati B, Akin Y, Çiftçi H, Culpan M, Yeni E, Caskurlu T. Comparison of Mini-percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery in Preschool-aged Children. Urology 2016; 101:21-25. [PMID: 27818164 DOI: 10.1016/j.urology.2016.10.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To compare the outcomes of mini-percutaneous nephrolithotomy (m-PCNL) and retrograde intrarenal surgery (RIRS) in treating renal stones in preschool-aged children. MATERIALS AND METHODS Forty-five patients treated with m-PCNL and 32 patients treated with RIRS for renal stones were compared retrospectively. The operative and postoperative outcomes of both groups were analyzed retrospectively. RESULTS The mean age and gender were similar between the groups. The mean stone size was 19.30 ± 4.21 mm for the RIRS group and 21.06 ± 5.61 mm for the PCNL group (P = .720). The mean operative times, fluoroscopy times, and hospitalization times were statistically higher in the PCNL group. The stone-free rates (SFRs) after a single procedure were 84.4% in the PCNL group and 75% in the RIRS group (P = .036). After auxiliary procedures, the overall SFRs reached 91.1% for the PCNL group and 90.6% for the RIRS group (P = .081). No major complications were observed for both groups. Minor complication (Clavien 1-3) rates were 15.5% and 12.5% for the PCNL and RIRC group, respectively (P = .385). CONCLUSION RIRS has some advantages over PCNL such as shorter hospitalization times, shorter fluoroscopy times, and shorter operative time in treating renal stones. However, PCNL achieves higher SFR after a single session.
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Affiliation(s)
- Eyyup Sabri Pelit
- Department of Urology, Faculty of Medicine, Harran University, Sanliurfa, Turkey.
| | - Gökhan Atis
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Bülent Kati
- Department of Urology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Yiğit Akin
- Department of Urology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Halil Çiftçi
- Department of Urology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Meftun Culpan
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ercan Yeni
- Department of Urology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Turhan Caskurlu
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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24
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ElSheemy MS, Daw K, Habib E, Aboulela W, Fathy H, Shouman AM, El Ghoneimy M, Shoukry AI, Morsi HA, Badawy H. Lower calyceal and renal pelvic stones in preschool children: A comparative study of mini-percutaneous nephrolithotomy versus extracorporeal shockwave lithotripsy. Int J Urol 2016; 23:564-70. [PMID: 27173126 DOI: 10.1111/iju.13093] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 03/01/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare outcomes of the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy for lower calyceal and renal pelvic stones in preschool children. METHODS From January 2010 to December 2014, single renal pelvic or lower calyceal calculi 10-25 mm in size in children (age ≤6 years) treated by either extracorporeal shockwave lithotripsy (64 patients) or the mini-percutaneous nephrolithotripsy technique (54 patients) were included. Extracorporeal shockwave lithotripsy was carried out by using a Dornier electromagnetic lithotripter. The mini-percutaneous nephrolithotripsy technique was through 14-Fr renal access using a 9.5-Fr semirigid ureteroscope with holmium:yttrium aluminium garnet lithotripsy. The two study groups were compared using Mann-Whitney, χ(2) -test or Fisher's exact test. RESULTS Stone parameters were similar in the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy groups in all patients, and in the pelvic (39 Miniperc, 52 extracorporeal shockwave lithotripsy) and lower calyceal (15 Miniperc, 12 extracorporeal shockwave lithotripsy) subgroups. Stone-free rates in the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy groups were 88.9% versus 43.8% (P < 0.001) and 94.4% versus 81.2% (P = 0.032) after first and last sessions, respectively. In the renal pelvis, they were 87.2% versus 50% (P < 0.001) and 94.9% versus 84.6% (P = 0.179), whereas in the lower calyx, they were 93.3% versus 16.7% (P < 0.001) and 93.3% versus 66.7% (P = 0.139) after first and last sessions, respectively. Retreatment rates in the mini-percutaneous nephrolithotripsy technique versus extracorporeal shockwave lithotripsy were 7.4% versus 50% (P < 0.001), 7.7% versus 46.2% (P < 0.001), and 6.7% versus 66.7% (P = 0.003) in all patients, renal pelvic and lower calyceal stones, respectively. No significant difference was found in complications (P = 0.521). Auxiliary procedures were required in 9.4% and 1.9% of children in the extracorporeal shockwave lithotripsy and mini-percutaneous nephrolithotripsy technique groups, respectively. CONCLUSIONS The mini-percutaneous nephrolithotripsy technique has significantly higher stone-free rates than extracorporeal shockwave lithotripsy for renal pelvic and lower calyceal stones (10-25 mm), with a lower retreatment rate and without a significant increase in complications.
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Affiliation(s)
- Mohammed S ElSheemy
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Kareem Daw
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Enmar Habib
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Waseem Aboulela
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Hesham Fathy
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed M Shouman
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Mohamed El Ghoneimy
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed I Shoukry
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Hany A Morsi
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Hesham Badawy
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
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25
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The modified ultra-mini percutaneous nephrolithotomy technique and comparison with standard nephrolithotomy: a randomized prospective study. Urolithiasis 2016; 45:209-213. [PMID: 27170277 DOI: 10.1007/s00240-016-0890-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/01/2016] [Indexed: 01/10/2023]
Abstract
To compare the success and complications of ultra-mini percutaneous nephrolithotomy (UPNL) and standard percutaneous nephrolithotomy (SPNL) techniques. We prospectively analyzed 50 patients who underwent SPNL, and 47 patients who underwent UPNL. The patients with a stone size equal to or smaller than 25 mm and we used flipping a coin as the randomization technique. The mean stone size was 20.9 ± 3.6 mm in SPNL, and 20.3 ± 3.0 mm in ultra-mini PNL groups. Stone free rates were 88 % (44/50 patients) and 89.3 % (42/47 patients) in SPNL and UPNL groups, respectively, without any significant difference in between (p = 0.33). No major complications were seen in the UPNL group. PNL has been modified into micro PNL and UPNL parallel to the technological advances to decrease the complications of PNL. When performed as we do UPNL may be an alternative method to SPNL without any additional smaller-calibred nephroscope and with a similar high success rate.
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Sebaey A, Khalil MM, Soliman T, Mohey A, Elshaer W, Kandil W, Omar R. Standard versus tubeless mini-percutaneous nephrolithotomy: A randomised controlled trial. Arab J Urol 2016; 14:18-23. [PMID: 26966588 PMCID: PMC4767792 DOI: 10.1016/j.aju.2015.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/19/2015] [Accepted: 11/08/2015] [Indexed: 11/28/2022] Open
Abstract
Objective To prospectively compare the outcome of standard mini-percutaneous nephrolithotomy (SmPCNL) versus tubeless mini-percutaneous nephrolithotomy (TmPCNL) as primary treatments of renal stones. Patients and methods In all, 80 patients with a solitary radio-opaque renal stone and candidates for PCNL were selected. The patients were randomly divided into two groups of 40, one group treated with SmPCNL and the other with TmPCNL. Patients and stone characters, as well as operative and postoperative data of both groups were compared and statistically analysed. Results There was no significant difference between the two groups for patient demographics and stone characteristics. There was no statistically significant difference between the two groups for the mean operative time, mean postoperative drop in haemoglobin, mean postoperative urine leakage, mean hospital stay, and stone-free rate. The mean (SD) postoperative dose of analgesia was statistically significantly higher in the SmPCNL group compared with the TmPCNL group, at 112.5 (48.03) versus 48.8 (43.5) mg, respectively. Conclusion Both procedures are safe and effective for managing renal stones, without any significant difference between the two procedures; however, the postoperative analgesic requirement is significantly higher in SmPCNL.
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Affiliation(s)
- Ahmed Sebaey
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Mostafa M Khalil
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Tarek Soliman
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed Mohey
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Walid Elshaer
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Wael Kandil
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Rabea Omar
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
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Ozden E, Mercimek MN. Percutaneous nephrolithotomy in pediatric age group: Assessment of effectiveness and complications. World J Nephrol 2016; 5:84-89. [PMID: 26788467 PMCID: PMC4707172 DOI: 10.5527/wjn.v5.i1.84] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/14/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
Management of kidney stone disease in pediatric population is a challenging condition in urology practice. While the incidence of kidney stone is increasing in those group, technological innovations have conrtibuted to the development of minimally invasive treatment of urinary stone disease such as mini-percutenous nephrolitotomy (mini-PCNL), micro-PCNL, ultra mini-PCNL. In this review we tried to evaluate the effect of new teratment techniques on pediatric kidney stones.
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Gamal WM, Hussein MM, Rashed EN, Mohamed AD, Mmdouh A, Fawzy F. Pediatric retrograde intra-renal surgery for renal stones <2 cm in solitary kidney. Indian J Urol 2016; 32:296-300. [PMID: 27843213 PMCID: PMC5054661 DOI: 10.4103/0970-1591.189723] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Management of renal stones in children with a solitary kidney is a challenge. In the current study, the efficacy and safety of retrograde intrarenal surgery (RIRS) in these children were determined. Patients and Methods: Records of children with renal stones who were treated at our institute between August 2011 and August 2014 were retrospectively assessed. Inclusion criteria were: Children with single renal stone <2 cm size, in a solitary kidney. A 7.5 Fr flexible ureteroscope (FURS) was introduced into the ureter over a hydrophilic guidewire under visual and fluoroscopic guidance - applying a back-loading technique. The stone was completely dusted using 200 μm laser fiber (0.2–0.8 joules power and 10–30 Hz frequency). At the end of the maneuver, a 5 Fr JJ stent was inserted into the ureter. The children were discharged home 24 h postoperative - provided that no complications were detected. Results: Fourteen children (3 girls and 11 boys) with median age 9.5 years (range 6–12) were included. The mean stone burden was 12.2 ± 1.5 mm (range 9–20). Stones were successfully accessed in all of the cases by the FURS except for 2 cases in whom a JJ stent was inserted into the ureter and left in place for 2 weeks to achieve passive dilatation. All of the stones were dusted completely. The immediate postoperative stone-free rate (SFR) was 79%, and the final SFR was 100% after 3 weeks. No intraoperative complications were observed. Conclusions: RIRS for renal stone <2 cm in children with a solitary kidney is a single-session procedure with a high SFR, low complication rate, and is a minimally invasive, natural orifice technique.
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Affiliation(s)
| | | | - El Nisr Rashed
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | | | - Ahmed Mmdouh
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - Farag Fawzy
- Department of Urology, Sohag University Hospital, Sohag, Egypt
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Daw K, Shouman AM, Elsheemy MS, Shoukry AI, Aboulela W, Morsi HA, Badawy H, Eissa MA. Outcome of Mini-percutaneous Nephrolithotomy for Renal Stones in Infants and Preschool Children: A Prospective Study. Urology 2015; 86:1019-26. [DOI: 10.1016/j.urology.2015.08.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 10/23/2022]
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Dede O, Sancaktutar AA, Dağguli M, Utangaç M, Baş O, Penbegul N. Ultra-mini-percutaneous nephrolithotomy in pediatric nephrolithiasis: both low pressure and high efficiency. J Pediatr Urol 2015; 11:253.e1-6. [PMID: 25964199 DOI: 10.1016/j.jpurol.2015.03.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/12/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The management of urolithiasis in children differs from adults because of anatomic and metabolic abnormalities. At present, various minimally invasive and invasive treatment strategies have been recommended to treat urinary tract Stones, including shock wave lithotripsy (SWL), standard percutaneous nephrolithotomy (PNL), mini-PNL, retrograde intrarenal surgery (RIRS), micro-PNL, and a new technique termed ultra-mini PNL (UMP). UMP is a new method for the treatment of kidney stones. The main difference between UMP and standard PNL or mini-PNL lies in the small access sheath and in its design. A 9.5F pediatric compact cystoscope was used (Figure). A major advantage of UMP is that it provides similar stone-free rates when compared with standard PNL, with lower intrarenal pressure than micro-PNL. OBJECTIVE The aim of the study was to determine the applicability and safety of UMP in the treatment of pediatric kidney stones. PATIENTS AND METHODS We retrospectively reviewed the files of 39 kidney stones in children who had undergone UMP between May 2011 and October 2014. The indications for UMP included stones resistant to SWL, stones requiring repeated sessions of SWL, and stones size larger than 20 mm. RESULTS The study included 17 females and 22 males, with a mean age of 5.8 ± 4.6 years. The mean hemoglobin loss was 0.9 ± 0.6 mg/dL and none of the patients required a blood transfusion. The complication rate of the PNL procedure was 15.3% (n = 6). Complete clearance was achieved in 32 patients (82%) with UMP monotherapy, which increased to 34% (87.1%) 4 weeks after the operation. DISCUSSION Management of urolithiasis necessitates a balance between stone clearance and morbidity related to the procedure. SWL often leads to persistent residual stones. The developing RIRS can minimize the risks associated with bleeding and visceral injury, but sometimes the abnormal pelvicaliceal anatomy and poor imaging of the flexible ureteroscopy may impact its success rate and applications. It has been reported that PNL can be performed safely and effectively to achieve a higher stone-free rate; however, it has serious complications such as bleeding that requires blood transfusion in 11-14% of the cases with increased risk of kidney loss. The recent development of smaller sheaths allows tract formation with minimal damage to the renal parenchyma, thereby reducing procedure-related morbidity without diminishing its therapeutic efficacy. CONCLUSION The most important advantage of this surgical technique that has been developed is similar stone-free rates to standard PNL and lower intrarenal pressure than micro-PNL. Our experience supports that UMP is safe and effective for the management of renal stones in children.
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Affiliation(s)
- Onur Dede
- Department of Urology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey.
| | | | - Mansur Dağguli
- Department of Urology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Mazhar Utangaç
- Department of Urology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Okan Baş
- Department of Urology, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Necmettin Penbegul
- Department of Urology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
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Dağgülli M, Sancaktutar AA, Dede O, Utanğaç MM, Bodakçi MN, Penbegül N, Hatipoğlu NK, Çakmakçı S. Minimally invasive percutaneous nephrolithotomy: an effective treatment for kidney stones in infants under 1 year of age. A single-center experience. Urolithiasis 2015; 43:507-12. [DOI: 10.1007/s00240-015-0787-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
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Affiliation(s)
- Paul Erotocritou
- Stone Unit, University College London Hospitals Foundation NHS Trust, UK
| | - Naima Smeulders
- Department of Urology, Great Ormond St Hospital for Children NHS Foundation Trust, UK
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Song G, Guo X, Niu G, Wang Y. Advantages of tubeless mini-percutaneous nephrolithotomy in the treatment of preschool children under 3 years old. J Pediatr Surg 2015; 50:655-8. [PMID: 25840082 DOI: 10.1016/j.jpedsurg.2014.11.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 10/20/2014] [Accepted: 11/18/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE Tubeless mini-percutaneous nephrolithotomy (MPCNL) for treating renal calculi was introduced in response to concerns over the use of adult nephrolithotomy apparatus in small children. However, it is unclear whether tubeless mini-PCNL (MPCNL) is of any benefit in the treatment of children. This study therefore aimed to assess the possible benefits of MPCNL, as compared to standard PCNL, in preschool children. METHODS Seventy-eight preschool children under 3 years with renal calculi were randomized into two groups (PCNL and MPCNL). Operative time, hemoglobin decrease, blood transfusion rate, postoperative complications and length of hospital stay in the two groups were statistically compared. RESULTS Recovery time was significantly shorter for patients receiving MPCNL than those treated with standard PCNL (4.6 versus 7.7 days, P<0.05). CONCLUSIONS Treating preschool children with tubeless percutaneous nephrolithotomy has advantages over standard PCNL, including faster recovery and shorter hospital stay.
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Affiliation(s)
- Guanglu Song
- Department of urology, The First Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Xiaoli Guo
- Department of urology, The First Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Gang Niu
- Department of urology, The Hospital of Kepin County, Akesu 843000, China
| | - Yujie Wang
- Department of urology, The First Hospital of Xinjiang Medical University, Urumqi 830054, China.
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Resorlu B, Sancak EB, Resorlu M, Gulpinar MT, Adam G, Akbas A, Ozdemir H. Retrograde intrarenal surgery in pediatric patients. World J Nephrol 2014; 3:193-197. [PMID: 25374812 PMCID: PMC4220351 DOI: 10.5527/wjn.v3.i4.193] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/23/2014] [Accepted: 08/29/2014] [Indexed: 02/06/2023] Open
Abstract
Urinary tract stone disease is seen at a level of 1%-2% in childhood (< 18 years). In recent years, however, there has been a marked increased in pediatric stone disease, particularly in adolescence. A carbohydrate- and salt-heavy diet and a more sedentary lifestyle are implicated in this increase. Although stone disease is rare in childhood, its presence is frequently associated with metabolic or anatomical disorders or infectious conditions, for which reason there is a high possibility of post-therapeutic recurrence. Factors such as a high possibility of recurrence and increasing incidence further enhance the importance of minimally invasive therapeutic options in children, with their expectations of a long life. In children in whom active stone removal is decided on, the way to achieve the highest level of success with the least morbidity is to select the most appropriate treatment modality. Thanks to today’s advanced technology, renal stones that were once treated only by surgery can now be treated with minimally invasive techniques, from invasion of the urinary system in an antegrade (percutaneous nephrolithotomy) or retrograde (retrograde intrarenal surgery) manner or shock wave lithotripsy to laparoscopic stone surgery. This compilation study examined studies involving the RIRS procedure, the latest minimally invasive technique, in children and compared the results of those studies with those from other techniques.
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Elderwy AA, Gadelmoula M, Elgammal MA, Osama E, Al-Hazmi H, Hammouda H, Osman E, Abdullah MA, Neel KF. Percutaneous nephrolithotomy in children: A preliminary report. Urol Ann 2014; 6:187-91. [PMID: 25125889 PMCID: PMC4127852 DOI: 10.4103/0974-7796.134255] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 04/27/2014] [Indexed: 12/26/2022] Open
Abstract
Objectives: The recurrence of pediatric nephrolithiasis, the morbidity of repeated open surgical treatment as well as our experience in percutaneous nephrolithotomy (PNL) in adult patients, all derived us to shift to PNL for managing renal stones >1.5 cm in pediatric patients. Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients. Materials and Methods: During the period of the month between May 2011 and April 2013, 38 children (47 renal units) underwent PNL for renal stones 1.5-5 cm in length. Patient demographics, stone characteristics, and clinical outcome were prospectively studied. Data of those who underwent conventional and tubeless PNL were compared. Median follow-up period was 12 months (range: 6-24). Results: The median age at presentation was 8-year (range: 3-12). The operative time ranged from 30 to 120 min (median 90). Overall stone clearance rate was 91.5% after single PNL. The median hospital stay was 3 days. Auxiliary procedures were successful for the remaining 4 patients (nephroscopic clearance in one and shockwave lithotripsy in 3). Tubeless PNL was performed in 17 renal units with a comparable outcome to conventional ones. The perioperative complications were noted in 5/47 (10.6%) of all procedures (Clavien Grade II in 4 and Clavien Grade IIIa in 1) and were managed conservatively. Conclusions: Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible if performed by a well-experienced endourologist. Tubeless PNL is a better choice for children.
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Affiliation(s)
- Ahmad A Elderwy
- Department of Urology, Division of Pediatric Urology, Assiut University Hospitals, Assiut, Egypt
| | - Mohamed Gadelmoula
- Department of Urology, Division of Pediatric Urology, Assiut University Hospitals, Assiut, Egypt
| | - Mohamed A Elgammal
- Department of Urology, Division of Pediatric Urology, Assiut University Hospitals, Assiut, Egypt
| | - Ehab Osama
- Department of Urology, Division of Pediatric Urology, Assiut University Hospitals, Assiut, Egypt
| | - Hamdan Al-Hazmi
- Department of Surgery, Division of Urology, College of Medicine, King Saud University, Saudi Arabia
| | - H Hammouda
- Department of Urology, Division of Pediatric Urology, Assiut University Hospitals, Assiut, Egypt
| | - Esam Osman
- Department of Urology, Division of Pediatric Urology, Assiut University Hospitals, Assiut, Egypt
| | - Medhat A Abdullah
- Department of Urology, Division of Pediatric Urology, Assiut University Hospitals, Assiut, Egypt
| | - Khalid Fouda Neel
- Department of Surgery, Division of Urology, College of Medicine, King Saud University, Saudi Arabia
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Bodakci MN, Daggülli M, Sancaktutar AA, Söylemez H, Hatipoglu NK, Utangaç MM, Penbegül N, Ziypak T, Bozkurt Y. Minipercutaneous nephrolithotomy in infants: a single-center experience in an endemic region in Turkey. Urolithiasis 2014; 42:427-33. [PMID: 25004801 DOI: 10.1007/s00240-014-0677-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/23/2014] [Indexed: 11/28/2022]
Abstract
The objective of the study is to evaluate the effectiveness and safety of miniaturized percutaneous nephrolithotomy (mini-PNL) method in infantile patients <3 years of age diagnosed with renal stones. We studied 48 renal units in 40 patients of infantile patients <3 years of age who underwent mini-PCNL at our institute. The mean age of the patients was 24.02 (5-36) months. The mean diameter of the stones was 22.3 mm (11-45 mm). Intrarenal access was achieved under fluoroscopic (n = 43) or ultrasonographic (n = 5) guidance under general anesthesia. A 20 Fr peel-away sheath, a 17 Fr rigid nephroscope and a pneumatic intracorporeal lithotripsy were used. Mean operative time for PNL was 85 (25-135) min. Mean fluoroscopy time was estimated as 3.7 min. The mean hospital stay was 4.3 days (2-10). Mean hemoglobin loss was 0.89 g/L (11.56-10.67) and three of the patients, including one case during the perioperative period, required blood transfusions. Colonic perforation developed in one case. In two patients, urinary drainage persisted for more than 24 h after withdrawal of the nephrostomy tube. Seven patients developed urinary tract infections (UTI). At the end of the postoperative first week, the stone-free rate was estimated to be 81.2 %. In conclusion, for percutaneous management of renal stones in the infantile age group, mini-PNL is an applicable treatment modality that can be applied through small incisions. It has higher stone-free rates, shorter hospital stays, and excellent esthetic outcomes. In this age group especially, surgical exposure to hypothermia and radiation should be avoided.
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Affiliation(s)
- Mehmet Nuri Bodakci
- Medical Faculty, Department of Urology, Dicle University, Diyarbakir, Turkey
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Akin Y, Yucel S. Long-term effects of pediatric extracorporeal shockwave lithotripsy on renal function. Res Rep Urol 2014; 6:21-5. [PMID: 24892029 PMCID: PMC4011895 DOI: 10.2147/rru.s40965] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Extracorporeal shock wave lithotripsy (ESWL) is a well-known and successful treatment modality. In addition, it can be used in premature infants. ESWL is used to treat kidney and ureter stones in children. However, although it is a preferred noninvasive treatment in that setting, there is debate about its long-term effects on growing kidneys in children. Objectives To investigate the long-term effects of pediatric ESWL on renal function in light of updated literature. Methods PubMed and Medline were searched for studies on ESWL in a pediatric population with keywords including efficacy, child, kidney calculi, ureter calculi, lithotripsy, injury, vascular trauma, and shock waves. The research was limited to the English literature during a period from 1980 to 2014. In total, 3,000 articles were evaluated, but only 151 papers were considered. Only the manuscripts directly related to the reviewed subjects were included in the current study. Results However, the acute effects of ESWL in kidney are well-described. Although there are limited studies on the long-term effects of ESWL in children, there is a widespread opinion that ESWL is not affecting renal functions in the long-term. Conclusion ESWL is a safe, effective, and noninvasive treatment option in children. Although ESWL can cause some acute effects in the kidney, there is no long-term effect on the growing kidneys of children.
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Affiliation(s)
- Yigit Akin
- Department of Urology, Harran University School of Medicine, Sanliurfa, Turkey
| | - Selcuk Yucel
- Department of Urology, Acibadem University School of Medicine, Istanbul, Turkey
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Goyal NK, Goel A, Sankhwar SN, Singh V, Singh BP, Sinha RJ, Dalela D, Yadav R. A critical appraisal of complications of percutaneous nephrolithotomy in paediatric patients using adult instruments. BJU Int 2014; 113:801-10. [DOI: 10.1111/bju.12506] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Neeraj Kumar Goyal
- Department of Urology; King George's Medical University (Formerly, Chhatrapati Shahuji Maharaj Medical University); Lucknow India
| | - Apul Goel
- Department of Urology; King George's Medical University (Formerly, Chhatrapati Shahuji Maharaj Medical University); Lucknow India
| | - Satya Narayan Sankhwar
- Department of Urology; King George's Medical University (Formerly, Chhatrapati Shahuji Maharaj Medical University); Lucknow India
| | - Vishwajeet Singh
- Department of Urology; King George's Medical University (Formerly, Chhatrapati Shahuji Maharaj Medical University); Lucknow India
| | - Bhupendra Pal Singh
- Department of Urology; King George's Medical University (Formerly, Chhatrapati Shahuji Maharaj Medical University); Lucknow India
| | - Rahul Janak Sinha
- Department of Urology; King George's Medical University (Formerly, Chhatrapati Shahuji Maharaj Medical University); Lucknow India
| | - Divakar Dalela
- Department of Urology; King George's Medical University (Formerly, Chhatrapati Shahuji Maharaj Medical University); Lucknow India
| | - Rahul Yadav
- Department of Urology; King George's Medical University (Formerly, Chhatrapati Shahuji Maharaj Medical University); Lucknow India
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Percutaneous nephrolithotomy for the treatment of radiolucent renal stones in children: is it different opaque stone treatment? Urolithiasis 2013; 42:81-6. [PMID: 24136423 DOI: 10.1007/s00240-013-0610-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/26/2013] [Indexed: 12/29/2022]
Abstract
We aimed to evaluate the effectiveness of percutaneous nephrolithotomy (PNL), stone-free rates, and related complications in children with radiolucent renal stones. A total of 56 patients aged <16 years from four institutions were enrolled in our study. Asymptomatic, clinically insignificant residual fragments measuring <4 mm or a complete stone-free status was accepted as the criterion for clinical success. Complications were evaluated according to the modified Clavien classification. The mean age of the patients was 7.8 ± 4.5 years. The mean stone size was calculated as 24.07 ± 10.4 mm. The median operative and fluoroscopy times were 53.2 min (15-170 min) and 172.4 s (5-520 s), respectively. The success rate after PNL monotherapy was 87.4%; the total success rate with shock wave lithotripsy used as an auxillary treatment method was detected as 94.6%. The total complication rate was 19.6% (11 patients). No adjacent organ injury was observed. All of the complications that occurred were minor according to the Clavien classification (Clavien Grades I-II). PNL can be applied to radiolucent pediatric renal stones in children with similar success, and complication rates as noted for radiopaque stones.
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Zeng G, Zhao Z, Wan S, Zhong W, Wu W. Comparison of children versus adults undergoing mini-percutaneous nephrolithotomy: large-scale analysis of a single institution. PLoS One 2013; 8:e66850. [PMID: 23826158 PMCID: PMC3691256 DOI: 10.1371/journal.pone.0066850] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 05/13/2013] [Indexed: 12/26/2022] Open
Abstract
Objective As almost any version of percutaneous nephrolithotomy (PCNL) was safely and efficiently applied for adults as well as children without age being a limiting risk factor, the aim of the study was to compare the different characteristics as well as the efficacy, outcome, and safety of the pediatric and adult patients who had undergone mini-PCNL (MPCNL) in a single institution. Methods We retrospective reviewed 331 renal units in children and 8537 renal units in adults that had undergone MPCNL for upper urinary tract stones between the years of 2000–2012. The safety, efficacy, and outcome were analyzed and compared. Results The children had a smaller stone size (2.3 vs. 3.1 cm) but had smilar stone distribution (number and locations). The children required fewer percutaneous accesses, smaller nephrostomy tract, shorter operative time and less hemoglobin drop. The children also had higher initial stone free rate (SFR) (80.4% vs. 78.6%) after single session of MPCNL (p<0.05); but no difference was noted in the final SFR (94.7% vs. 93.5%) after auxiliary procedures. The complication rate (15.6% vs. 16.3%) and blood transfusion rate (3.1% vs. 2.9%) were similar in both group (p>0.05). Both groups had low rate of high grade Clavien complications. There was no grade III, IV, V complications and no angiographic embolization required in pediatric group. One important caveat, children who required multiple percutaneous nephrostomy tracts had significant higher transfusion rate than in adults (18.8% vs. 4.5%, p = 0.007). Conclusions This contemporary largest-scale analysis confirms that the stone-free rate in pediatric patients is at least as good as in adults without an increase of complication rates. However, multiple percutaneous nephrostomy tracts should be practiced with caution in children.
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Affiliation(s)
- Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Rodrigues PL, Vilaça JL, Oliveira C, Cicione A, Rassweiler J, Fonseca J, Rodrigues NF, Correia-Pinto J, Lima E. Collecting system percutaneous access using real-time tracking sensors: first pig model in vivo experience. J Urol 2013; 190:1932-7. [PMID: 23714434 DOI: 10.1016/j.juro.2013.05.042] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2013] [Indexed: 12/24/2022]
Abstract
PURPOSE Precise needle puncture of the renal collecting system is an essential but challenging step for successful percutaneous nephrolithotomy. We evaluated the efficiency of a new real-time electromagnetic tracking system for in vivo kidney puncture. MATERIALS AND METHODS Six anesthetized female pigs underwent ureterorenoscopy to place a catheter with an electromagnetic tracking sensor into the desired puncture site and ascertain puncture success. A tracked needle with a similar electromagnetic tracking sensor was subsequently navigated into the sensor in the catheter. Four punctures were performed by each of 2 surgeons in each pig, including 1 each in the kidney, middle ureter, and right and left sides. Outcome measurements were the number of attempts and the time needed to evaluate the virtual trajectory and perform percutaneous puncture. RESULTS A total of 24 punctures were easily performed without complication. Surgeons required more time to evaluate the trajectory during ureteral than kidney puncture (median 15 seconds, range 14 to 18 vs 13, range 11 to 16, p=0.1). Median renal and ureteral puncture time was 19 (range 14 to 45) and 51 seconds (range 45 to 67), respectively (p=0.003). Two attempts were needed to achieve a successful ureteral puncture. The technique requires the presence of a renal stone for testing. CONCLUSIONS The proposed electromagnetic tracking solution for renal collecting system puncture proved to be highly accurate, simple and quick. This method might represent a paradigm shift in percutaneous kidney access techniques.
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Affiliation(s)
- Pedro L Rodrigues
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal; 3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Algoritmi Center, School of Engineering, University of Minho, Guimarães, Portugal.
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Abstract
Interventional radiologists are playing an increasingly important role in pediatric urologic intervention, working closely with the pediatric urologist. Interventional radiologists are frequently asked to establish percutaneous access to the renal collecting system prior to nephrolithotomy. Additionally, procedures such as percutaneous nephrostomy, ureteral stent placement and exchange, and renal parenchymal biopsy are frequently encountered requests. This article will review these common procedures and highlight techniques and pathology that are unique to the pediatric population.
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Affiliation(s)
- Luke Linscott
- Section of Vascular and Interventional Radiology, Mallinckrodt Institute of Radiology, St. Louis, Missouri
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Minimally invasive percutaneous nephrolithotomy in preschool age children with kidney calculi (including stones induced by melamine-contaminated milk powder). Pediatr Surg Int 2012; 28:1021-4. [PMID: 22729672 DOI: 10.1007/s00383-012-3112-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2012] [Indexed: 12/30/2022]
Abstract
PURPOSE This study was undertaken to assess the safety and efficacy of minimally invasive percutaneous nephrolithotomy (mini-PCNL) using ureteroscope and pneumatic intracorporeal lithotripsy in preschool age children with kidney calculi. METHODS We studied 27 renal units in 20 patients of preschool age (≤ 6 years) who underwent mini-PCNL at our institute. The mean age was 42.6 months (range 14-68 months). The average stone burden was 1.85 cm (range 0.9-2.8 cm). Eight patients aged 14 to 58 months had been exposed to melamine-tainted powdered formula. The mini-PCNL was performed with an X-ray-guided peripheral puncture. Minimal tract dilatation was undertaken to fit a 14-16 Fr peel-away sheath. Ureteroscope and pneumatic intracorporeal lithotripsy were used to fragment the stones. RESULTS Complete clearance was achieved in 23 renal units (85.2 %) with mini-PCNL monotherapy. This has increased to 92.6 % after adjunctive ESWL. The average fall in hemoglobin was 1.28 g/dL. None of the patients required blood transfusion. The median length of hospital stay was 8.2 days. Patients were followed up every 6 months for 2 years. There has been only one recurrence of stone and no long-term complications. CONCLUSION Mini-PCNL is a effective treatment for pediatric kidney stones refractory to extracorporeal shock wave lithotripsy, including stones induced by melamine-contaminated milk powder. The "mini-PCNL" technique, which uses ureteroscope and pneumatic intracorporeal lithotripsy, is a safe and feasible modality for treating renal calculi in preschool age children.
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Resorlu B, Unsal A, Tepeler A, Atis G, Tokatli Z, Oztuna D, Armagan A, Gurbuz C, Caskurlu T, Saglam R. Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in children with moderate-size kidney stones: results of multi-institutional analysis. Urology 2012; 80:519-23. [PMID: 22673546 DOI: 10.1016/j.urology.2012.04.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 04/01/2012] [Accepted: 04/06/2012] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To compare the outcomes of miniaturized percutaneous nephrolithotomy (mini-perc) and retrograde intrarenal surgery (RIRS) in children for 10- to 30-mm renal calculi by evaluating operative data, stone-free rates, and associated complications. METHODS The records of 201 pediatric patients who underwent mini-perc (n = 106) or RIRS (n = 95) for intrarenal stones of 10- to 30-mm size were reviewed retrospectively. The χ(2) test was applied to compare the success rates, postoperative complications, and blood transfusion rates, and the Mann-Whitney U test was used to compare the means of hospital stay, fluoroscopy, and operative time for mini-perc and RIRS. RESULTS The stone-free rate was 84.2% for the RIRS group and 85.8% for the mini-perc group after a single procedure (P = .745). These percentages increased to 92.6% and 94.3% with adjunctive therapies for RIRS and mini-perc, respectively. Minor complications classified as Clavien I or II occurred in 17% and 8.4% in mini-perc and RIRS, respectively. No major complications (Clavien III-V) occurred in either group. Overall complication rates in mini-perc were higher, but the differences were not statistically significant (P = .07). However, 7 patients in the mini-perc group received blood transfusions, whereas none of the children in the RIRS group were transfused (P = .015). The mean hospital stay, fluoroscopy, and operation times were significantly longer in the mini-perc group. CONCLUSION This study demonstrates that RIRS is an effective alternative to mini-perc in pediatric patients with intermediate-sized renal stones. Operative time, radiation exposure, hospital stay, and morbidities of percutaneous nephrolithotomy (PNL) can be significantly reduced with the RIRS technique.
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Affiliation(s)
- Berkan Resorlu
- Kecioren Training and Research Hospital, Department of Urology, Ankara, Turkey.
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Aghamir SMK, Salavati A, Aloosh M, Farahmand H, Meysamie A, Pourmand G. Feasibility of Totally Tubeless Percutaneous Nephrolithotomy Under the Age of 14 Years: A Randomized Clinical Trial. J Endourol 2012; 26:621-4. [DOI: 10.1089/end.2011.0547] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Alborz Salavati
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Aloosh
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hasan Farahmand
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alipasha Meysamie
- Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Pourmand
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Dogan HS, Kilicarslan H, Kordan Y, Celen S, Oktay B. Percutaneous nephrolithotomy in children: does age matter? World J Urol 2011; 29:725-9. [DOI: 10.1007/s00345-011-0692-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 04/30/2011] [Indexed: 12/01/2022] Open
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