Minimally Invasive Surgical Approaches to Kidney Stones in Children
ABSTRACT The existing treatment options for pediatric urolithiasis are endoscopic methods. Extracorporeal shockwave lithotripsy (SWL) is the first-line option for most of the kidney stones smaller than 1 cm in diameter. For larger stones or refractory cases, minimally invasive surgical methods are preferred. Percutaneous nephrolithotomy (PCNL) is a well-established treatment modality for most patients. This technique has shown evolution also in children so that miniaturized or tubeless methods could now be performed. Recent series show that flexible ureteroscopy is also becoming an important treatment option in the pediatric urology armamentarium for treating the calyceal and lower pole stones. Open surgery has a very limited role and it may be of use when there is a need to do an adjuvant reconstructive surgery. With the increasing experience, laparoscopic surgery is becoming an alternative option that may have potential to replace the open techniques.
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ABSTRACT: Purpose: We aimed to compare the outcomes of microperc and shockwave lithotripsy (SWL) for treatment of kidney stones in children. Patients and Methods: The medical records of 145 patients with opaque and single kidney stones treated with either SWL or microperc under the age of 15 years were retrospectively reviewed. Both groups were compared in terms of fluoroscopy and operation time, re-treatment, complications, success rate, and secondary and total number of procedures. Results: Microperc and SWL were performed on 37 and 108 pediatric patients, respectively. The mean age of the patients was 5.91±4.03 years (1-15) and 8.43± 4.84 (1-15) years in the SWL and microperc groups, respectively (p=0.004). The mean stone size was 11.32±2.84 (5-20) mm in the SWL group and 14.78±5.39 (6-32) mm in the microperc group (p˂0.001). In the SWL group, 31 (28.7%) patients underwent a second SWL session and 6 (5%) had a third session. Finally, 95 (88%) patients were stone-free at the end of the SWL sessions. In the microperc group, the stone-free rate was 89.2% in a single session (p=0.645). The mean duration of hospitalization was 49.2 ± 12.3 (16-64) hours in the microperc group and 8.4 ± 2.3 (6-10) hours per one session in the SWL group (p= <0.001). The fluoroscopy time was significantly longer in the microperc group compared with the SWL group (147.3±95.3 seconds vs. 59.6±25.9 seconds, p= <0.001). The rate of requirement for an auxiliary procedure was higher in the SWL group than in the microperc group. The overall complication rates for the microperc and SWL groups were 21.6% and 16.7%, respectively (p=0.498). Conclusions: The results of our study demonstrate that microperc provides a similar stone-free rate and a lower additional treatment rate compared with SWL in the treatment of kidney stone disease in children.Journal of endourology / Endourological Society 05/2013; 27(9). DOI:10.1089/end.2013.0066 · 2.10 Impact Factor
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ABSTRACT: To investigate whether aging affects surgical outcomes by comparing the results of two patient groups undergoing PNL: those over 60 and those under 60. A retrospective screen was made for patients undergoing conventional PNL surgery for renal stones performed in two separate centers between 2010 and 2013. 520 patients included were classified into age groups: patients aged 18-59 comprised Group-1 and those aged over 60 comprised Group-2. Those between 60-69 years (sexagenarian) were assigned to Group-2a; 70-79 years (septuagenarian) to Group-2b; and 80-89 years (octogenarian) to Group-2c. Patients' demographic characteristics (accompanying comorbidities, ASA scores, body mass indices and stone size) and perioperative values (duration of surgery and hospital stay, success and complication rates) were compared between the groups. Mean stone size was similar in groups (30.1 ± 15.5 vs. 31.5 ± 15.4 mm, p = 0.379). The mean ASA value for the patients in Group-1 was 1.61; significantly lower than that in the other groups (p = 0.000). The level of accompanying comorbidities in Group-1 was significantly lower than that of the other groups (p = 0.000). The mean duration of surgery, postoperative hematocrit drop, complication and success rate were statistically similar in Groups 1 and 2 (p = 0.860, p = 0.430, p = 0.7, and p = 0.66, respectively). The duration of hospital stay was significantly shorter in the patients in Group-1 compared to those in Group-2 (p = 0.008). In experienced hands, PNL can be safely and reliably performed in the treatment of renal stones in elderly patients.11/2014; 43(2). DOI:10.1007/s00240-014-0742-4