Use of Retroperitoneoscopic Intracorporeal Lithotripter in the Treatment of Nephrolithiasis in Children

Abstract

PURPOSE The objective is to assess the efficacy of intracorporeal lithotripsy (StoneBreaker) by retroperitoneoscopical approach for treating pediatric struvita stones in the renal pelvis. MATERIAL AND METHODS We have treated two patients with unilateral pelvic struvita calculi using the StoneBreaker, a novel device, portable contact pneumatic intracorporeal lithotripter. The age at surgery was 2 and 4 years old. The patients presented with abdominal pain, nausea and vomiting and recurrent urinary tract infection due to Proteus and Pseudomona spp. Diagnosis was made by plain radiographs and renal ultrasonography. The calculi were located in renal pelvis and inferior caliceal group, with associated mild hydronephrosis. Retroperitoneoscopy was the minimally invasive method perfomed to access to the pelvic stone. Stone clearance was documented on a radiograph taken the day after the surgery. RESULTS 2 patients had retroperitoneoscopy approach by 3 ports. The size of the stones was 3 and 4,2 cm, respectively. Surgical technique is described. Lithotripsy was continued until stone fragmentation was sufficient to permit safe and easy removal of all fragments. Any evidencce of urothelial trauma was noted. The number of shocks required for successful clearance was 25 y 38, respectively. The renal pelvis was closed and a Penrose drain was left in the retroperitoneum. In the 2 patients a double-J stent was maintained postoperatively. The hospital stay was 3 days. Both patients (100%) became stone free. CONCLUSIONS The StoneBreaker appears to be an effective portable intracorporeal lithotripter that should plays an important role among endourological options for lithotripsy in children. Retroperitoneoscopy is an effective, minimally invasive, low-morbidity alternative to open nephrolitotomy for treatment of pelvicaliceal complex stones in the pediatric age.