Minimally Invasive Surgical Approaches to Kidney Stones in Children
Department of Urology, Uludag University, Faculty of Medicine, 16059, Bursa, Turkey.Current Urology Reports (Impact Factor: 1.51). 06/2012; 13(4):298-306. DOI: 10.1007/s11934-012-0259-8
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 under the age of 15 years with opaque and single kidney stones treated with either SWL or microperc were retrospectively reviewed. Both groups were compared in terms of fluoroscopy and operative 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.
Article: Ureteroscopy for Urinary Calculi[Show abstract] [Hide abstract]
ABSTRACT: The incidence of pediatric urinary stone disease is increasing due to the environmental conditions in association with the improving health services and diagnostic modalities. The technological advancements provided more durable, flexible, and small caliber instruments. With the accumulated experience in adults, the treatment choice in pediatric urinary stone disease also shifted to endourological approaches. Ureteroscopy is one of the most important endourological choices of treatment. Technique is similar as in adults. However, having and using the appropriate-sized instruments is important as well as being experienced. In patients with proper indication who were treated by proper endourological principles, both semirigid and flexible ureteroscopy have very high rates of success with minimal complications.
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ABSTRACT: Traditionally the mainstay of stone treatment in child has been shock wave lithotripsy but pediatric management of urolithiasis has continued to evolve with advances in both technology and skills. This chapter discusses the increasing utility of ureteroscopy in children as well as the feasibility and efficacy of percutaneous nephrolithotomy. Additionally, indications, outcomes, and limitations for both types of management are explored. A step-by-step approach to performing both ureteroscopy and percutaneous nephrolithotomy is outlined along with the appropriate equipment needed for each type of management. Overall, ureteroscopy and percutaneous nephrolithotomy are important treatment modalities in the management armamentarium of the pediatric urologist.
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