Calculi In Pediatric Patients Research Articles

Pediatric Stone Surgery: What Is Hot and What Is Not.

We aim to highlight recent advances in technology and techniques for surgical management of urinary tract calculi in pediatric patients. Percutaneous nephrolithotomy (PCNL) is classically performed in the prone position. The supine PCNL was first attempted to overcome the shortcomings of difficult airway access, patient and surgeon discomfort. The supine PCNL, and subsequent modifications, has been successfully described in the pediatric population. Classically, PCNL has also been classically concluded with obligate placement of a nephrostomy tube and bladder catheter. Recently, tubeless and totally tubeless PCNL reduces pain and duration of hospitalization with satisfactory surgical outcomes in children. Finally, we describe the use of thulium laser technology, which offers improved efficacy in stone treatment and may supplant the current dominant technologies in coming years. Recent advances in pediatric stone surgery include supine PCNL, miniaturized PCNL instrumentation, tubeless procedures, and thulium laser technology.

Utilization of the Glue-clot Technique for Removal of Small Lower Pole Calculi in Pediatric Patients: Case Series

Glue-clot technique has been described as a method to remove small stone fragments in adults undergoing endourological management of renal calculi. In this case series, we share our experience of using this technique for retrieval of stone fragments in 4 children who underwent ureterorenoscopy. The fragments were mainly located in the lower calyces rendering stone extraction challenging. We were able to achieve complete clearance in all patients. This series represents the first use of glue-clot technique in pediatric ureterorenoscopy.

744 - Success rate of one session of extracorporeal shock wave lithotripsy for renal calculi in pediatric patients: A report from national reference center

744 - Success rate of one session of extracorporeal shock wave lithotripsy for renal calculi in pediatric patients: A report from national reference center

V09-02 ROBOTIC ASSISTED LAPAROSCOPIC PYELOLITHOTOMY IN A PEDIATRIC PATIENT WITH HORSESHOE KIDNEY

INTRODUCTION AND OBJECTIVE: The incidence of nephrolithiasis in children has increased by 6-10% annually over the last two decades. Percutaneous nephrolithotomy, extracorporeal shockwave lithotripsy, and ureteroscopy are accepted treatment modalities in children with normal anatomy and <2cm stone burden. The management of large volume nephrolithiasis in pediatric patients with complex anatomy such as horseshoe kidney has not been well described. This study aims to demonstrate that robotic assisted laparoscopic pyelolithotomy is a feasible treatment option for a pediatric patient with a staghorn calculus in a horseshoe kidney moiety. METHODS: The patient is a 7-year-old female with trisomy 13. She has a horseshoe kidney with nonfunctioning right moiety secondary to ureteropelvic junction obstruction status post multiple pyeloplasties and a ureterocalicostomy. She also has reflux nephropathy of the right moiety status post ureteral reimplant as an infant. Her baseline creatinine is 0.4. The patient was found to have a staghorn calculus in the left moiety during evaluation for recurrent urosepsis. She underwent a robotic assisted laparoscopic pyelolithotomy via a transperitoneal approach. RESULTS: The calculus was removed in its entirety via robotic assisted laparoscopic pyelolithotomy. The Foley catheter was removed on postoperative day 2, and the Jackson Pratt drain was removed on postoperative day 3 after which she was discharged home. Chemical analysis of the specimen revealed a struvite stone. The ureteral stent was removed 1 month postoperatively. The patient has been doing well on six-month follow up with no additional episodes of urosepsis. CONCLUSIONS: Robotic assisted laparoscopic pyelolithotomy can be safely performed to treat staghorn calculi in pediatric patients with complex anatomy including horseshoe kidneys. Source of Funding: None

437 - Mini-perc for renal calculi in pediatric patients: Does size matter? A prospective randomised study

437 - Mini-perc for renal calculi in pediatric patients: Does size matter? A prospective randomised study

Fluoroscopy-free ultrasonography-guided percutaneous nephrolithotomy in pediatric patients: a single-center experience.

To present the safety and efficacy of fluoroscopy-free ultrasound-guided PCNL for the treatment of renal calculi in pediatric patients of all ages. 30 children with mean age of 5years (6months-12years) underwent totally ultrasound-guided PCNL from March 2013 to August 2016. The pyelocalyceal system was punctured in prone position using only ultrasonography guidance, and the tract was dilated using a single shot dilation technique. No fluoroscopy was used during any of the stages of renal access. The procedure was performed using adult-sized instruments. The mean stone size was 27.1±8.7mm. Mean access time was 4.3±2min. Mean nephroscopic time was 34.6±15.2min. Mean hospital stay of patients was 3days (range 2-5). 21 patients were stone-free after the procedure (70% success rate). Only four patients out of 30 experienced postoperative complications. The results of this study showed that fluoroscopic-free ultrasound-guided PCNL in pediatric patients of all ages is safe, highly efficient, and minimizes potential radiation exposure risks associated with the procedure.

Percutaneous nephrolithotomy of bilateral staghorn renal calculi in pediatric patients: 12years experience in a tertiary care centre.

To assess the outcomes of percutaneous nephrolithotomy (PCNL) in bilateral staghorn calculi in pediatric patients, we have performed a retrospective analysis. Staghorn calculus is defined as stone that fills a greater part of the pelvic-caliceal system. Still, in developing countries, patients may present with staghorn calculus. PCNL is the preferred treatment modality for staghorn calculus both in adult and children. Our study included fifty-one pediatric patients (<15years) of bilateral staghorn calculi from 2004 to 2015. Staged PCNL was done after 2-3days if needed and opposite side PCNL was performed after 10-14days. Fifty-one patients with bilateral staghorn renal calculi underwent PCNL. The mean age of the study group was 10.25±2.13 (range 3-15). Mean stone burden was 778.3+613.4 (range 231-3850mm2). Forty-five patients underwent single puncture, twenty-two patients underwent double punctures whereas six patients underwent triple punctures during first session PCNL procedure. Most common puncture location was through the superior calyx (58.82%). The mean operating time was 77.25+30.21 (range 58-145). After the first session PCNL, the success rate was 76.47%. Thirteen patients (17 renal units) underwent relook PCNL and seven patients underwent ESWL. Overall complication noted in twenty-four (47.05%) cases. Most of the complications were minor grade. Percutaneous nephrolithotomy for staghorn calculus in children needs expertise. PCNL in B/L staghorn renal calculus in children is safe and effective. B/L staghorn renal calculi with compromised renal function have higher chance of complications including bleeding.

Extracorporeal shockwave lithotripsy for renal stones in pediatric patients: A multivariate analysis model for estimating the stone‐free probability

To define factors affecting the stone-free rate of extracorporeal shockwave lithotripsy in the treatment of pediatric renal calculi, and to establish a regression model for pretreatment prediction of stone-free probability. From January 1999 through February 2012, 207 children with mean age 6.4 ± 3.8 years underwent shockwave lithotripsy with Dornier Lithotripter S for treatment of renal stones. The stone-free rate was evaluated 3 months after the last shockwave lithotripsy session with non-contrast computed tomography. Treatment success was defined as complete clearance of the stones with no residual fragments. Multivariate logistic regression analysis was used to identify independent risk factors and to predict the probability of being stone free. The mean length of the stone was 11.6 ± 4 mm. The stone-free rate was 71%. Independent factors that adversely affect stone-free rate were increasing stone length and calyceal site of the stone. Relative risks for not being free of stones were 1.123 for stone length, 2.673 for stones in the upper or middle calyx and 4.208 for lower calyx stones. Stone length and location are prognostic factors determining stone-free rate after shockwave lithotripsy for renal calculi in pediatric patients. Based on our analysis, shockwave lithotripsy should be recommended for renal pelvis stones up to 24 mm, upper or middle calyceal stones up to 15 mm and lower calyceal stones up to 11 mm.

Complications and Associated Factors of Pediatric Extracorporeal Shock Wave Lithotripsy

We determined the safety, efficacy and complications of extracorporeal shock wave lithotripsy in managing pediatric urolithiasis and analyzed possible factors affecting the complication rate. We retrospectively reviewed 128 patients younger than 16 years who had undergone extracorporeal shock wave lithotripsy with a Lithostar® lithotripter between January 2000 and December 2010. Stone clearance and complications were assessed at postoperative week 1, and months 1 and 3. Success was defined as no radiological evidence of stone, or fragments 4 mm or less. Treatment failure was analyzed to find any correlation with stone size. Complications were assessed with a specific focus on rehospitalizations during postoperative week 1. The overall success rate was 93.5% (115 of 123 patients). Repeat treatment rate was 56.1% (69 patients). Extracorporeal shock wave lithotripsy failed in 8 children, who subsequently required ancillary procedures. Mean stone size in the treatment failure group was 17.03 mm, compared to 13.04 mm in the successfully treated group. A total of 22 patients (17.8%) had complications in postoperative week 1 but only 19 (15.4%, 12 boys and 7 girls) were rehospitalized at that time. Presence of a metabolic risk factor was the only predictive factor for complications. By comparison, we found a lower success rate and higher ancillary procedure rate in the group with complications. Extracorporeal shock wave lithotripsy is effective for pediatric urolithiasis, with a small but substantial morbidity rate. Parents should be informed about possible rehospitalization following extracorporeal shock wave lithotripsy due to complications independent of stone size.

Safety and efficacy of PCNL for management of staghorn calculi in pediatric patients

Objectives There are few reports on the use of PCNL for staghorn calculi in children. We evaluated the safety and efficacy of this technique, using adult equipment, in children below 16 years of age. Methods Data for pediatric patients undergoing PCNL for staghorn renal calculi was prospectively recorded. A staghorn calculus was defined as a branched stone occupying more than one part of the collecting system. A standard fluoroscopy guided PCNL was performed in the prone position using adult nephroscopes. Stone clearance was assessed on fluoroscopy and X-ray in all patients and an ultrasound or CT scan in selected cases. Results Beginning October 2007, 33 pediatric patients underwent 34 PCNLs at our center. 12 of these children had staghorn calculi. All patients had normal renal function and no metabolic abnormality. One child had a solitary kidney. In 5 children, the primary tract was placed into the superior calyx and 4 of these were above the 12th rib. A 21Fr nephroscope was used through a 24Fr tract in 9 children while a 26Fr nephroscope was used through a 30Fr tract in 3 cases. 10 children were managed through a single tract. One patient each required SWL and ureteroscopy for residual fragments. 11 patients had complete clearance while 1 had insignificant residue. One child required intravenous antibiotics for post-operative fever while another developed an abdominal collection that was managed conservatively. Conclusions PCNL is safe and effective in the management of pediatric staghorn calculi.

Treatment of renal calculi in pediatric patients with minimally invasive percutaneous nephrolithotomy

Objective To evaluate the technique and efficacy of minimally invasive percutaneous nephrolithotomy (MPCNL) for renal calculi in pediatric patients. Methods From April 2009 to December 2009, 12 pediatric patients (8 males and 4 females) with renal calculi were treated by MPCNL. The age ranged from 18 to 53 months (mean 32 months). All the 12 cases were diagnosed by KUB+IVU, ultrasonography and CT. The stone had average diameter of 1. 3 cm (ranged from 1. 0 to 1. 8 cm). Seven cases had simple renal pelvis stone and 5 cases had multiple renal calyx stone. UPJ stricture was not found in this series. General anaesthesia was applied. Renal transfixion pin was punctured to select renal calices by monitoring with ultrasonography. 12 - 16 F percutaneous renal access was successfully established in all cases and calculi were fragmented by pneumatic lithotripter. Results The average operative time of MPCNL was 74 min. Phase Ⅰ lithotripsy was underwent in all patients. The phase Ⅰ stone-free rate was 67%(8/12). One cases accepted second MPCNL. The calculus clearance rate reached 75%(9/12). Three cases had residual calculi ranged from 2 to 4 mm. One of whom had ESWL 2 weeks postoperatively. All cases were followed up for 1 - 7 months, all cases were in stone free status. Conclusion Regarding the advantages of less bleeding, high clearance rate, and shorter hospital stay, MPCNL is an effective and safe treatment option for renal calculi in pediatric patients. Key words: Kidney calculi; Nephrostomy, percutaneous

Chemical analysis of urinary calculi in pediatric patients exposed to infant formula milk powder contaminated with melamine

Objective To identify the main compositions of urinary calculi found in pediatric patients who had the history of exposing to infant formula milk powder contaminated with melamine and try to find out the urinary calculus formation mechanism in these patients.Methods Sixteen patients were studied.These infant patients with urinary calculi due to consumption of melamine tainted milk powder had been admitted to hospital from June,2008 to August,2008.The components of the urinary calculi were separated by liquid chromatograph,and identified by electrospray ionization mass spectrometry,electron bombard ionization mass spectrometry,Fourier transform infrared spectroscopy,and quantitatively determined by liquid chromatograph.Results The main chemical components of the urinary ealculi were melamine and uric acid.The molar ratio of uric acid tO melamine was 2:1.Conclusion The main urinary calculus formation mechanism in infant patients who exposed to the inrant formula milk powder contaminated with melamine is melamine and uric acid formed indissoluble complex. Key words: Urinary calculi; Infants; Melamine; Uric acid; Composition analysis

Current status of minimally invasive management of pediatric upper urinary tract calculi

The surgical management of pediatric upper urinary tract calculi has evolved from open surgery to minimally invasive techniques. With advancement in instrumentation, endourological procedures are being performed more commonly in children. However, the endourological management of renal and ureteral stones in the pediatric population is considered challenging, owing to the smaller size of the urinary tract. Various minimally invasive techniques that are being applied in the management of pediatric urolithiasis, include shock wave lithitripsy (SWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopy and a combination of these procedures. The role of SWL is well established and is considered the first line of treatment in the management of urinary calculi in pediatric patients. Recent reports have confirmed the safety of PCNL and ureteroscopy in children, although they are not as widely practiced in children as in adults. This article reviews literature published till October 2005, pertaining to the minimally invasive management of pediatric upper urinary tract calculi.<br>

Extracorporeal Shockwave Lithotripsy for Salivary Calculi in Pediatric Patients

Salivary gland lithiasis is uncommon in pediatric patients. Color Doppler ultrasonography (US) enables an accurate diagnosis of lithiasis to be made without exposure to the radiation of traditional imaging techniques. The development of minimally invasive techniques in the ENT field has made salivary lithotripsy a feasible alternative to traditional invasive surgery. The safety and efficacy of shock wave lithotripsy for salivary calculi were evaluated in pediatric patients. Seven children (5 males; age 4-15 years) with single calculi (mean diameter 4.4 mm) of the submandibular ( n = 4) and parotid glands ( n = 3) underwent extracorporeal electromagnetic shock wave lithotripsy (EESWL). In four cases the stone was intraductal (two submandibular and two parotideal) and in the remaining three cases it was intraparenchymal (two submandibular and one parotideal). In one case sedative anesthesia was performed. The mean number of therapeutic sessions was five. Patients were followed up clinically and with US for 6-72 months (mean 32 months). Complete disintegration of the calculi was achieved in five cases while in two cases a residual fragment < 2 mm in diameter was observed. None of the patients had recurrence of calculi in the treated gland. Mild self-limited adverse effects (pain, swelling of the gland, self-limiting bleeding from the duct, cutaneous petechiae) were observed in four cases. Our data suggest that EESWL is effective, safe and well tolerated; the minimal invasiveness of the technique suggests that EESWL should be used as the primary approach to salivary calculi in pediatric patients. The continuous US monitoring enables the efficacy of EESWL to be evaluated during both treatment and follow-up, with only slight discomfort for the pediatric patient.