Minimally Invasive Approaches in Pediatric Urolithiasis. The Experience of Two Italian Centers of Pediatric Surgery

Destro, Francesca; Selvaggio, G; Lima, Mario; Riccipetitoni, Giovanna; Klersy, Catherine; Salvo, Neil Di; Marinoni, Federica; Calcaterra, Valeria; Pelizzo, Glória

doi:10.3389/fped.2020.00377

Cited by 10 publications

(17 citation statements)

References 31 publications

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“…For this reason, percutaneous techniques using nephroscope or operative optic were developed, with the aim to remove bladder stones quickly in large fragments ( 12 – 15 ). With the increasing use of percutaneous techniques, an alternative solution to remove BS in children could be performing a percutaneous suprapubic bladder stone removal ( 16 ). Percutaneous cystolithotomy (PCCL) has been demonstrated to be adequate, safe and quick to perform in managing BS in children ( 13 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Management of Bladder Stones in Children

et al. 2021

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Background: Bladder stones (BS) are rare in children. Minimally invasive surgery (MIS) seems to be nowadays the procedure of choice to treat pediatric patients with BS. This study aimed to analyze retrospectively our experience with percutaneous cystolithotomy, endourological treatment with Holmium laser and robotic cystolithotomy in children with BS.Methods: We retrospectively analyzed the data of 13 children (eight boys and five girls) with BS who were treated at our centers between July 2013 and July 2020. The patients received three different MIS procedures for stones removal: five underwent robotic cystolithotomy, five underwent endourological treatment and three received percutaneous cystolithotomy (PCCL). We preferentially adopted endourological approach for stones <10 mm, percutaneous approach between 2014 and 2016 and robotic approach since 2016 for larger stones.Results: Mean patients' age at the time of diagnosis was 13 years (range 5–18). Ten/13 patients (76.9%) had primary BS and 3/13 patients (23.1%) had secondary BS. Mean stone size was 18.8 mm (range 7–50). In all cases the stones were removed successfully. One Clavien II post-operative complication occurred following PCCL (33.3%). All the procedures were completed without conversions. Operative time ranged between 40 and 90 min (mean 66) with no significant difference between the three methods (p = 0.8). Indwelling bladder catheter duration was significantly longer after PCCL (mean 72 h) compared with robotic and endourological approaches (mean 15.6 h) (p = 0.001). Hospitalization was significantly longer after PCCL (mean 7.6 days) compared with the other two approaches (mean 4.7 days) (p = 0.001). The endourological approach was the most cost-effective method compared with the other two approaches (p = 0.001).Conclusions: Minimally invasive management of bladder stones in children was safe and effective. Endourological management was the most cost-effective method, allowing a shorter hospital stay compared with the other procedures but it was mainly indicated for smaller stones with a diameter < 10 mm. Based upon our preliminary results, robotic surgery seemed to be a feasible treatment option for BS larger than 15–20 mm. It allowed to remove the big stones without crushing them with a safe and easy closure of the bladder wall thanks to the easy suturing provided by the Robot technology.

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Section: Introductionmentioning

confidence: 99%

Minimally Invasive Management of Bladder Stones in Children

et al. 2021

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“…The mean hospital stay was 3.4 ± 1.6 [1][2][3][4][5][6][7][8] days. The length of hospital stay was significantly longer in patients who underwent open surgeries than in those who went through MIP (4.1 ± 1.5 vs. 1.7 ± 0.8 days, p < 0.001).…”

Section: Resultsmentioning

confidence: 99%

Clinical Features and Surgical Outcomes of the Children With Urolithiasis at a Tertiary Care Hospital: First Report From Somalia

Eraslan¹,

Mohamed²,

Çimen³

2022

Front. Pediatr.

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IntroductionThere are very few studies regarding pediatric urolithiasis (PU) reported from Africa, and to date, no data have been presented from Somalia. This study evaluated the sociodemographic and radiological characteristics, treatment, and outcome data of the PU patients treated at Somalia's only tertiary care center.MethodThe data of all patients diagnosed with urolithiasis during a 6-year period were reviewed. Only pediatric (age <18) urolithiasis patients were included. Demographic parameters, radiological features, stone characteristics, treatment, and outcome data were collected and analyzed.ResultsOverall, 227 (127 male, 100 female) patients were included. The rate of PU was 8.1%. The mean patient age was 12.7 ± 3.2. More than two-thirds of the patients (n = 161, 70.9%) were adolescents. The stones were located in the kidney in 50.7%, the ureter in 33%, and the bladder in 14.5%. Distal ureteral stones (36%) accounted for the majority of ureteral stones, followed by the ureterovesical junction (26.7%) and proximal ureteral (24%) stones. The mean stone size was 16.2 mm. Most (42.3%) stones had a 10–20 mm diameter, while 23.3% were sized between 6 and 10 mm. Renal insufficiency was present in 5.3%. Among 227 patients, 101 (44.5%) underwent minimally invasive procedures including ureterorenoscopic lithotripsy (n = 40, 18%), retrograde intrarenal surgery (n = 30, 13.2%) and percutaneous nephrolithotomy (n = 31, 14%). Open pyelolithotomy was the most common surgery performed (n = 53, 22.3%). Surgical site infection developed following 3.5% of the open surgery cases. The stone-free rate was 91.3%. It was significantly higher in open cases (98%) compared to the cases performed via a minimally invasive approach (83%) (p = 0.02).ConclusionIn Somalia, PU is more common than in many other countries. Open surgery continues to be the primary treatment modality for children with urolithiasis due to the restricted endourology resources. However, minimally invasive approaches have evolved over the last years.

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“…According to our experience, when stone disease recurrence is not amenable with medical expulsive therapy or SWL, we recommend the use of flexible ureteroscopy with holmium laser lithotripsy. It has become an appropriate procedure for paediatric renal stones inferior to 20 mm supported by shorter operative time, reduced fluoroscopy time and less hospitalization time compared to PCNL 27,28 …”

Section: Discussionmentioning

confidence: 99%

Combined treatment of ureteropelvic junction obstruction and renal calculi with robot‐assisted laparoscopic pyeloplasty and laser lithotripsy in children: Case report and non‐systematic review of the literature

Scarcella

Tiroli

Torino

et al. 2021

Robotics Computer Surgery

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Objective(s) The incidence of urinary tract stone disease is steadily increasing in both adult and paediatric populations. This condition develops due to different factors: dietary or metabolic alterations, infection, and congenital anatomic malformations. Standard indications and treatments for children are analogous to the ones indicated for adults. Extracorporeal shock wave lithotripsy, ureterorenoscopy and percutaneous nephrolithotomy (PCNL) should be preferred to more invasive techniques. Moreover, the introduction of laparoscopic and robot‐assisted laparoscopic approaches have improved surgical outcomes, lowering the bleeding risk with higher stone‐free rates, even in complicated cases. Despite these well‐known improvements, there are few reports regarding laparoscopic robot‐assisted management for urinary tract stone disease in paediatric patients under the age of 10, especially with concomitant treatment of ureteropelvic junction obstruction and multiple calyceal stones. Patient and Method(s) A 4‐year‐old child was referred for recurrent right abdominal flank pain, macroscopic haematuria and a previous history of urinary tract infections. A computed tomography of the abdomen showed right ureteropelvic junction obstruction associated with multiple unilateral stones located in the renal pelvis and in the interpolar renal calyces. Due to its complexity, we held a multidisciplinary meeting with paediatric surgeons and nephrologists to determine optimal treatment. As a result, a combined robot‐assisted laparoscopic pyeloplasty (LP) and renal calculi holmium laser lithotripsy using a digital flexible ureteroscope through an abdominal robotic trocar was performed. No post‐surgical complications were recorded, and the patient was discharged within 48 h following surgery. At subsequent regular follow‐up examinations over a period of 24 months, no signs of recurrence were detected for both ureteropelvic junction obstruction and stone disease. Result(s) Robot‐assisted LP with concomitant laser lithotripsy is a reasonable treatment option for designated young paediatric patients with challenging ureteropelvic junction obstruction complicated by urolithiasis, especially in cases where stones are not amenable with standard procedures.

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Minimally Invasive Approaches in Pediatric Urolithiasis. The Experience of Two Italian Centers of Pediatric Surgery

Cited by 10 publications

References 31 publications

Minimally Invasive Management of Bladder Stones in Children

Minimally Invasive Management of Bladder Stones in Children

Clinical Features and Surgical Outcomes of the Children With Urolithiasis at a Tertiary Care Hospital: First Report From Somalia

Combined treatment of ureteropelvic junction obstruction and renal calculi with robot‐assisted laparoscopic pyeloplasty and laser lithotripsy in children: Case report and non‐systematic review of the literature

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