Abstract
This study aimed to report a multi-institutional experience with robot-assisted laparoscopic surgery (RALS) for treatment of urinary tract stones in children. The medical records of 15 patients (12 boys), who underwent RALS for urolithiasis in 4 international centers of pediatric urology over a 5-year period, were retrospectively collected. The median patient age was 8.5 years (range 4–15). Eleven/fifteen patients (73.3%) had concurrent uretero–pelvic junction obstruction (UPJO) and 2/15 patients (13.3%) had neurogenic bladder. Stones were in the renal pelvis in 8/15 (53.3%), in the lower pole in 3/15 (20%), in the bladder in 2/15 (13.3%), and in multiple locations in 2/15 (13.3%). One patient (6.6%) had bilateral multiple kidney stones. The median stone size was 10.8 mm (range 2–30) in upper tract location and 27 mm (range 21–33) into the bladder. Eleven patients with concomitant UPJO underwent simultaneous robot-assisted pyelolithotomy and pyeloplasty in 12 kidney units. Two patients with isolated staghorn stones received robot-assisted pyelolithotomy. Robot-assisted cystolithotomy was performed in two patients with bladder stones. The median operative time was 131.8 min (range 60–240). The stone-free rate was 80% following initial surgery and 100% after secondary treatment. Clavien 2 complications (hematuria, infections) were recorded in 5/15 patients (33.3%). Three/fifteen patients (20%) with residual renal stones were successfully treated using ureterorenoscopy (Clavien 3b). RALS was a feasible, safe and effective treatment option for pediatric urolithiasis in selected cases such as large bladder stones, bilateral kidney stones, staghorn stones or concomitant anomalies such as UPJO requiring simultaneous pyeloplasty.
Highlights
The incidence of pediatric urolithiasis is rapidly increasing worldwide [1]
There is still limited evidence regarding the role of robot-assisted laparoscopic surgery (RALS) in the management of pediatric urolithiasis [8]
Laparoscopic and robot-assisted approaches have been reported as viable treatment options in selected patients with large stones, anomalies of collecting system and complex stone burdens [7,8,9,10]
Summary
The main treatment options for urinary tract stones have been similar as those used in the adult population and included ureterorenoscopy (URS), retrograde intrarenal surgery (RIRS), extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL) [2,3,4] These endo-urological techniques may not be adequate in patients presenting large impacted pelvic and ureteric stones, staghorn stones, an anomalous collecting system, or a synchronous pathology such as uretero–pelvic junction obstruction (UPJO), which should be preferably treated with the renal stones in a single surgical session [5]. The morbidity of open surgery can be significant [9], whereas drawbacks of laparoscopic stone surgery include challenges with ureteral stenting, limited dissection and intra-corporeal suturing, as well as increased risk of complications such as urinary leakage [10]
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