Endourology Methods in Pediatric Population for Kidney Stones Located in Lower Calyx: FlexURS vs. Micro PCNL (MicroPERC®)

Abstract

Kidney stone disease in children is always a therapeutic challenge. It is a multifactorial condition and it should be approached, diagnosed and treated as such. One of the biggest challenges is kidney stones located in the lower renal calyx. There are currently three main surgical techniques to treat this condition: ESWL—Extracorporeal Shock Wave Lithotripsy, RIRS—Retrograde IntraRenal Surgery, and PCNL—PerCutaneous Nephro-Lithotripsy. In pediatric population, the most frequently used method is ESWL, and in the event of failure, endoscopic procedures are the second-best choice. In this article, a sample of 53 children admitted to a tertiary medical center was examined. Thirty-eight of those children underwent flexible URS, while the remaining 15—micro PCNL. The average size of the deposit in the former group was 12.2 mm, against 13.5 mm in the latter. The full Stone Free Rate (SFR) was achieved in RIRS at 84.21 and 86.7% in percutaneous nephrolithotripsy. Flexible ureterorenoscopy and MicroPERC are two comparably effective methods for treating lower calyx stones of any size. However, according to our data, flexible ureterorenoscopy carries a lower risk of complications and inpatient care (with the mean of 3 days). The learning curve for these procedures in pediatric urology is long and relies on a limited number of patients. The number of pediatric patients qualifying for these procedures is restricted also due to the high efficacy of extracorporeal shock wave lithotripsy in pediatric population. Radiation exposure is an important factor in every endoscopy procedure and should never exceed the limits set in the ALARA protocol. ESWL remains to this day the treatment of choice for stone disease in children and can be performed under ultrasound control. For many parents, it is a first-choice treatment preference for their child due to its greater apparent safety, although data on this remains insufficient. Prospective, randomized, multicenter trials are definitely needed.

Pediatric Urolithiasis: Current Surgical Strategies and Future Perspectives

“…In a retrospective study including 24 infants undergoing “micro-PNL” for renal stones, Dede et al ( 18 ) recorded a stone-free rate of 83.3% with 4 patients complaining of post-operative renal colic and 2 patients experiencing post-operative fever. Similarly, a stone-free rate of 86.7% was reported in a recent paper involving 15 patients undergoing “micro-PCNL” for kidney stones located in lower calyx ( 19 ).…”

Comparative efficacy and safety between Micro-Percutaneous Nephrolithotomy (Micro-PCNL) and retrograde intrarenal surgery (RIRS) for the management of 10–20 mm kidney stones in children: A systematic review and meta-analysis

“…Following the full-text article evaluation, 11 articles were excluded. The remaining four articles [ [12] , [13] , [14] , [15] ] were further analyzed as presented in Fig. 1 .…”

“…It has been shown to be feasible and may be more effective in pediatric patients [ 11 ]. Recent studies comparing Micro-PCNL and RIRS in pediatrics indicated that these procedures have their respective advantages and disadvantages [ [12] , [13] , [14] , [15] ]. In this review, we aim to evaluate the efficacy and safety between Micro-PCNL and RIRS in treating moderately sized pediatric kidney stones.…”

Minimally invasive surgery for pediatric renal and ureteric stones: A therapeutic update

“…Besides, a proportion of the patients need additional auxiliary procedures to achieve complete stone clearance. The main contraindications for ESWL in children are coagulation dysfunction, cardiopulmonary disease, lithotripsy passage obstruction, uncontrolled urinary tract infection, diabetes, skeletal malformations, excessive obesity, active infectious diseases, renal insufficiency, and hemangioma around the stone ( 6 , 17 ).…”

“…In the past decades, the treatment methods for PU have changed dramatically because of the development of equipment, technological innovation, and the increasing experience of pediatric urologists. The original traditional open surgery is replaced by the current minimally invasive surgeries, including extracorporeal shockwave lithotripsy (ESWL), ureteroscopy (URS), and retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), laparoscopic, and robot-assisted surgery ( 5 , 6 ). Since there are many minimally invasive treatment methods, pediatric urologists must be familiar with the advantages and shortcomings of each treatment option.…”