Stones In Pediatric Patients Research Articles

Prospective Evaluation of Outcomes and Complications in Ultra-Mini-Percutaneous Nephrolithotomy for Pediatric Nephrolithiasis: A Three-Year Study

Objective: This prospective study aimed to evaluate the outcomes and complications of Ultra-Mini Percutaneous Nephrolithotomy (UM-PCNL) in pediatric patients with renal calculi over a three-year period (2021-2023). We assessed Stone-Free Rates (SFR), operative success and perioperative complications to determine the efficacy and safety of UM-PCNL in children. Methods: Seventy-eight pediatric patients (aged 1-17 years) underwent UM-PCNL for renal calculi larger than 10 mm. Preoperative imaging, including ultrasonography and computed tomography, was utilized to assess stone size and location. Surgical outcomes, including SFR, operative time and the need for second-look procedures, were evaluated. Complications were graded using the Clavien-Dindo classification. Statistical analysis was conducted using SPSS, with a significance threshold of p < 0.05. Results: The mean stone size was 18.2 ± 5.4 mm and the overall SFR after a single UM-PCNL procedure was 78.2%. Clinical success (defined as either stone-free status or clinically insignificant residual fragments) was achieved in 89.7% of patients. The mean operative time was 67 ± 22 minutes. Second-look procedures were required in 11.5% of cases. The overall complication rate was 19.2%, with no major complications (Clavien grade III-V). Minor complications included transient fever (6.4%), hematuria (12.8%) and urinary leakage (5.1%). Conclusion: UM-PCNL is a safe and effective procedure for managing pediatric nephrolithiasis, offering high stone-free rates and low complication risks. The use of smaller instruments reduces renal trauma, bleeding and the need for blood transfusions. These findings support UM-PCNL as a first-line treatment option for larger renal stones in pediatric patients. Further studies with long-term follow-up are recommended to assess recurrence and long-term renal function outcomes.

International Alliance of Urolithiasis (IAU) guidelines on the management of pediatric urolithiasis.

The aim of this study was to construct the sixth in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis (IAU) that by providing a clinical framework for the management of pediatric patients with urolithiasis based on the best available published literature. All recommendations were summarized following a systematic review and assessment of literature in the PubMed database from January 1952 to December 2023. Each generated recommendation was graded using a modified GRADE methodology. Recommendations are agreed upon by Panel Members following review and discussion of the evidence. Guideline recommendations were developed that addressed the following topics: etiology, risk factors, clinical presentation and symptoms, diagnosis, conservative management, surgical interventions, prevention, and follow-up. Similarities in the treatment of primary stone episodes between children and adults, incorporating conservative management and advancements in technology for less invasive stone removal, are evident. Additionally, preventive strategies aiming to reduce recurrence rates, such as ensuring sufficient fluid intake, establishing well-planned dietary adjustments, and selective use pharmacologic therapies will also result in highly successful outcomes in pediatric stone patients. Depending on the severity of metabolic disorders and also anatomical abnormalities, a careful and close follow-up program should inevitably be planned in each pediatric patient to limit the risk of future recurrence rates.

Predictors of follow-up of pediatric stone patients after surgical intervention

We investigated if socioeconomic and demographic factors predict post-surgical follow-up in pediatric stone patients. All patients having kidney stone surgery at a single academic pediatric hospital over a 5 year period (2016-2020) were identified through the use of CPT® codes specific to ureteroscopy, shock wave lithotripsy, and percutaneous nephrolithotomy. Electronic charts were reviewed for patient demographics, stone characteristics, and characteristics of intervention. Unique patients with a scheduled post-operative follow-up office visit following a first time stone surgery were included in the patient cohort (Figure 1). Primary outcome was attendance of a scheduled provider visit within 6 months after surgery. Secondary outcomes included completion of scheduled post-operative imaging and 24-h urine study. Univariable analysis was performed. 195 pediatric patients, a median age of 15.4 years (IQR: 11.34, 17.14) at surgery, were identified. The majority were non-Hispanic white (86.2%) and female (62.1%). Most had undergone ureteroscopy alone (85.6%). Of the 195 patients, 146 (74.9%) attended a post-operative office visit. Indicators of lower socioeconomic status, such as having public insurance and being from a single-parent home, were associated with not attending a scheduled follow-up visit (p<0.01 and p=0.02, respectively). Patients with a pre-operative urology clinic visit were more likely to follow-up with a clinic visit (p=0.02), while those with a larger total stone burden treated were more likely to undergo ordered imaging (p<0.01). We found that indicators of lower socioeconomic status, such as having public insurance status and being in a single-parent household, were associated with lower pediatric follow-up compliance after kidney stone surgery, while patients seen in the urology clinic preoperatively were more likely to attend follow-up. Identifying factors that may predict non-compliance could be used to help at-risk patient populations.

Comparison of two methods for treatment of 1-2cm kidney stones in pediatric patients: mini PCNL and RIRS.

This study aimed to compare the results of retrograde intrarenal surgery (RIRS) and mini-percutaneous nephrolithotomy (mini-PCNL) for the treatment of 1-2cm kidney stones in pediatric patients. The records of patients under the age of 18 years who were diagnosed with unilateral 1-2cm kidney stones for the first time and underwent endoscopic surgery between February 2008 and April 2022 were retrospectively examined. The patients were divided into two groups: mini-PCNL and RIRS surgery. Parameters such as age, gender, number of stones, side, size and localization were examined. The main endpoint of the study was to compare stone-free rates (SFR) one month after both surgeries. Surgery and fluoroscopy times, postoperative hospital stay, hemoglobin decrease and complication rates were compared between the groups. SFR was evaluated one month after surgery by direct urinary system radiography and USG or CT. A total of 58 patients were included in the study. There were 35 patients in the mini-PCNL group and 23 patients in the RIRS group. Table1 shows the demographic and clinical characteristics of both groups. There was no significant difference between the groups in terms of age, gender, stone size, location, side and density. Calcium oxalate stones were observed at a higher rate in both groups. Mean fluoroscopy time was higher in the mini-PCNL group (p = 0.001). The mean surgery time was lower in the mini-PCNL group (p = 0.024). The mean hemoglobin decrease was greater in the percutaneous group (p = 0.039). There were no differences between the groups in terms of postoperative hospital stay, complication rates, and SFR one month after surgery. Although mini-PCNL seems to be more advantageous in terms of operation time compared to RIRS, it is disadvantageous in terms of average fluoroscopy time, radiation received and average hemoglobin decrease.

Comparison of supine-prone percutaneous nephrolithotomy methods in the treatment of kidney stones in pediatric patients: prospective randomized study.

Mini-PCNL is one of the most effective surgical methods in the treatment of kidney stones in pediatric patients. In this study, we aimed to compare PCNL in the supine-prone position in pediatric patients (especially operation time, postop complications, hospital stay and stone-free rates).We conducted our study in a randomized and prospective manner. Patients with lower pole stones larger than 1cm, stones larger than 1.5cm in the pelvis, upper pole, midpole or multiple locations, and patients who did not respond to ESWL or whose family that preferred mini-PCNL to be the primary treatment were included in the study. Patients with any previous kidney stone surgery, patients with coagulation disorders and patients with retrorenal colon were excluded from the study. Between 2021 and 2023, a total of 144 patients underwent PCNL. 68 of these patients had supine PCNL and 76 prone PCNL. Postoperative Clavien grade1 complication occurred in a total of 7 patients in the prone position; Clavien grade1 complication occurred in 1 patient in the supine position. The mean operation time for prone PCNL was 119.88 ± 28.32min, and the mean operative time for supine PCNL was 98.12 ± 14.97 the mean hospitalization time in prone PCNL was 3.56 ± 1.12days, and 3.00 ± 0.85days in supine PCNL. In conclusion, supine PCNL is a safe and effective method in the treatment of pediatric kidney stones and postoperative complications were observed to be less; the operation time and hospital stay were shorter in supine PCNL.

Factors effecting the success of retrograde intrarenal surgery in pediatric patients with renal stones: The experience of two tertiary centres with 368 renal units

Currently, in the field of pediatric urology, the primary aim of surgical approaches for the treatment of renal stone disease is to provide a stoneless state through minimally invasive methods, and to prevent the damage that such stones may cause in the urinary system and stone recurrence. The aim of this study was to evaluate the efficacy and safety of RIRS and the factors affecting its success in the surgical treatment of renal stones in pediatric patients. Data from 357 pediatric and 368 renal units were collected retrospectively. The recorded parameters were age, gender, location and burden of the stone, and presence of postoperative residual stones. The stone location was the upper pole in 28 (7.6%) patients, the middle pole in 44 (12%), the pelvis in 98 (26.6%), the lower pole in 139 (37.8%), and multiple locations in 59 (16%) patients. A stoneless state was achieved in 277 (75.3%) units, while 91 units (24.7%) had residual stones at the end of the first month. In the multivariate analysis, the development of residual stones was found to be significantly associated with age (odds ratio [OR], 1.123; p=0.012) and stone location (OR, 3.142; p=0.018). RIRS is an endourological procedure with a high success rate in the achievement of a stoneless state in both pediatric and adult age groups, with an 82-100% success rate reported in various studies. A full stoneless state was achieved in 277 (75.3%) units after the initial RIRS in the present study, and full stone clearance was achieved in 304 units after the second RIRS session, with a success rate of 82.6%. A limitation of our study is that it was not performed by a single surgeon, and stone samples could not be taken from all patients for stone analysis. RIRS has also been associated with a high success rate in the endoscopic treatment of renal stones and is an efficient and safe method with a minimal rate of complications, especially in the pediatric age group.

First worldwide report on safety and efficacy of using small 7.5 Fr scope for pediatric ureteroscopy: prospective pilot series from Europe.

Although pediatric urolithiasis remains relatively uncommon, its global prevalence is on the rise. Technological advances have led to miniaturization of instruments especially in the form of single use scopes. As the evidence on the use of small single use ureteroscopes in children is scarce, we have conducted a pilot two-center study to analyze the outcomes of pediatric patients treated with the Pusen 7.5 Fr single use scopes at our institutions. This study included consecutive pediatric patients with urinary stones treated with the small Pusen 7.5 Fr single use ureteroscope. The study was conducted at two large European tertiary endourology centers that specialize in pediatric kidney stone management. Patient data and outcomes were prospectively collected, and analysis was performed regarding patient demographics, stone parameters, as well as stone free rate (SFR), operating time, and complications. In this pilot study, 26 patients were included with a median age of 12 years (7.0-16.0) and a male to female ratio of 14:12. The mean cumulative stone size was 15.15 mm (SD ±11.1) and multiple stones were present in 9 (34.6%) patients. Pre-operative stent, access sheath and post-operative stent usage was done in 12 (46.2%), 23 (88.5%) and 13 (50%) patients respectively. The median operative time was 47 minutes (IQR: 40.0-63.8). Following the initial procedure 24 (92.3%) patients were stone free, while no intra or postoperative complications were observed. Our study demonstrates that the use of the small 7.5 single use ureteroscope is safe and efficient for the treatment of urinary stones in pediatric patients with high stone-free rates and no complications noted in our series. While this might become a standard of care in future, to confirm and validate our findings further studies with larger cohorts are warranted.

Bladder Stones in Pediatric Patients with Bladder Dysfunction: a Review of Pathophysiology and Management

Bladder Stones in Pediatric Patients with Bladder Dysfunction: a Review of Pathophysiology and Management

Outcomes of Flexible Ureteroscopy vs Extracorporeal Shock Wave Lithotripsy for Renal Stones in Pediatric Patients: A European Association of Urology Urolithiasis Guidelines Systematic Review and Meta-Analysis.

We sought to determine which treatment between flexible ureteroscopy and shock wave lithotripsy has a better stone-free rate in pediatric patients (<18 years) with renal or proximal ureteric stones (<2 cm). Subanalysis for all outcomes for randomized controlled trials only. Using PubMed, Web of Science, and the Cochrane database, we identified studies (randomized clinical trials and prospective comparative nonrandomized studies) published until August 2022 reporting surgical outcomes of pediatrics patients undergoing flexible ureteroscopy and shock wave lithotripsy with renal or proximal ureteric stones <2 cm (PROSPERO ID: CRD42022378790). Only randomized controlled trials were considered for meta-analysis. Stone-free rate, operative time, and complications were analyzed. Analysis was performed in R. A total of 6 studies identified, of which 3 were randomized clinical trials and 4 had data on renal stones. A total of 669 patients were analyzed. Mean age ranged from 4.4 to 12.4 years. The shock wave lithotripsy group presented a range of stone-free rate between 21 and 90% while the flexible ureteroscopy group presented a range of stone-free rates between 37% and 97%. Meta-analysis of randomized controlled trials only (n=302) demonstrated significantly higher stone-free rate in flexible ureteroscopy vs shock wave lithotripsy (RR = 1.17, 95% CI: 1.04-1.33, P = 0.01), operative time (mean difference = +16.4 minutes, 95% CI: 7.3-25.5, P < 0.01) and hospital stay (mean difference = +0.25 days, 95% CI: 0.14-0.36, P < 0.001). But no difference in fluoroscopy exposure time (mean difference = -21.0 seconds, 95% CI: -42.6 to 0.56, P = 0.07), Clavien I-II (RR = 1.23, 95% CI: 0.71-2.12, P = 0.45) or Clavien III-V complications (RR = 1.04, 95% CI: 0.32-3.42, P = 0.95). Flexible ureteroscopy has a significantly higher stone-free rate than shock wave lithotripsy, with no difference in complication rate or fluoroscopy exposure time, and significantly higher operative times and hospital stay. However, the current evidence base for this is weak and further randomized trials are needed.

MP10-19 THE USE OF ALPHA-ADRENERGIC ANTAGONISTS IN PEDIATRIC NEPHROLITHIASIS: A SYSTEMATIC REVIEW

You have accessJournal of UrologyCME1 Apr 2023MP10-19 THE USE OF ALPHA-ADRENERGIC ANTAGONISTS IN PEDIATRIC NEPHROLITHIASIS: A SYSTEMATIC REVIEW Firas Haddad, Beirut, Lebanon, Walid Farhat, and Shannon Taylor Smith Cannon Firas HaddadFiras Haddad More articles by this author , Beirut Beirut More articles by this author , Lebanon Lebanon More articles by this author , Walid FarhatWalid Farhat More articles by this author , and Shannon Taylor Smith CannonShannon Taylor Smith Cannon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003225.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urolithiasis is increasingly common in children, and alpha-adrenergic antagonists are often used as a treatment option. We conducted a systematic review of randomized controlled trials and cohort studies to assess the use of alpha-adrenergic antagonists in the treatment of kidney stones in pediatric patients. METHODS: A search of MEDLINE, PubMed, Cochrane, EMBASE, and Google Scholar was conducted on May 20, 2022. Inclusion criteria included patients <18 years old with any kidney stones treated with alpha-adrenergic antagonists reported in cohort studies and randomized control trials. Outcomes included stone expulsion time, stone passage rate, mean number of pain episodes, and mean need for analgesics. Following deduplication, two reviewers screened the articles with a third reviewer available for adjudication. We performed data extraction of the selected articles, and the results were assimilated and synthesized qualitatively. RESULTS: Nine studies were selected out of 254 articles and 1,039 patients were included, outlined in Table 1. Five of 6 studies measuring stone expulsion time reported a statistically significant decrease in expulsion time in the treatment group compared to the control. Seven studies measured the stone expulsion rate, and 5 reported a statistically significant increased expulsion rate in the treatment group. In assessment of pain, four studies reported a decrease in the mean number of pain episodes in the treatment group and two studies showed a decreased analgesic requirement for treatment compared to control. Two studies assessed the use of alpha-adrenergic antagonists after shock wave lithotripsy, and both found alpha-adrenergic not superior to watchful waiting for spontaneous stone passage. CONCLUSIONS: Our results suggest that alpha-adrenergic antagonists are effective at decreasing the stone expulsion time and increasing the stone passage rate. Limitations included variable reporting of intervention and outcome data. We conclude that alpha-adrenergic antagonists are a useful adjunct therapy to consider in the treatment of pediatric nephrolithiasis. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e121 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Firas Haddad More articles by this author Beirut More articles by this author Lebanon More articles by this author Walid Farhat More articles by this author Shannon Taylor Smith Cannon More articles by this author Expand All Advertisement PDF downloadLoading ...

MP35-18 MINI-PERCUTANEOUS NEPHROLITHOTOMY VERSUS STANDARD PERCUTANEOUS NEPHROLITHOTOMY FOR THE MANAGEMENT OF 20- TO 40-MM RENAL CALCULI : SAFETY AND EFFICACY

You have accessJournal of UrologyCME1 Apr 2023MP35-18 MINI-PERCUTANEOUS NEPHROLITHOTOMY VERSUS STANDARD PERCUTANEOUS NEPHROLITHOTOMY FOR THE MANAGEMENT OF 20- TO 40-MM RENAL CALCULI : SAFETY AND EFFICACY Aymen Sakly, Walid Zakhama, Nejm Jleli, Aymen Mnasser, and Yassine Binous Aymen SaklyAymen Sakly More articles by this author , Walid ZakhamaWalid Zakhama More articles by this author , Nejm JleliNejm Jleli More articles by this author , Aymen MnasserAymen Mnasser More articles by this author , and Yassine BinousYassine Binous More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003269.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The incidence of small and medium-sized stones is rising. A list of minimally invasive approaches is available and urologists must choose the best therapeutic option to ensure complete stone clearance with less morbidity. Initially, mini-percutaneous nephrolithotomy (mPCNL) was developed to manage renal stones in pediatric patients. Then, this approach has become a frequent treatment modality even in high stone burden. Although an increasing number of studies have been published on mPCNL, randomized clinical studies are rare. We conducted this study to assess the safety and the effectiveness of mPCNL versus sPCNL. METHODS: We conducted a prospective randomized study between September 2018 and April 2021 including all patients with a 20 to 40 mm kidney stone managed by percutaneous approach. Exclusion criteria were pediatric population, abnormal coagulopathy state, abnormal renal anatomy and multiple-tract percutaneous access. All procedures were performed by the same surgeon in the supine position. In all, 110 patients were randomized into two groups: Group A: 59 patients underwent sPCNL using a 24 Fr nephroscope through a 30 Fr sheath; and group B: 51 patients underwent mPCNL procedure using minimally invasive PCNL system: 12 Fr nephroscope with a 16,5/17,5 Fr sheath after a single-step dilatation. For both groups, demographic data, stone characteristics, operative data, and postoperative data were recorded prospectively. All patients were evaluated with a non-contrast spiral CT 1 month after the operation, to determine the final stone-free status. Statistic evaluation was performed using Student's t test. RESULTS: The mean age was 51.1±12.2 and 44.4±16.3 years for sPCNL group and mPCNL group, respectively. The median stone size was 33.1±9.8 mm for group A and 28.8±11.2 mm for group B. The operative time was higher in group B (135±57.8 min vs 110±41.1 min, p=0.033). According to Clavien–Dindo classification, no statistical difference was detected between the groups in terms of complication rates (p=0.09). However, the rates of hemoglobin drop and transfusion rates were significantly higher in sPCNL than mPCNL (1.53 g-dL vs. 0.73 g-dL, p<0.015). Only one patient required transfusion in group B compared with six patients in group A. The hospital stay was found to be significantly shorter in the mPCNL group (2.75±0.7 vs. 3.8±1.1 days, p=0.02). The success rate in the sPCNL group was higher than mPCNL group in terms of stone clearance after 1 month, but this difference was statistically insignificant (88.2 vs. 86%, p=0.59). CONCLUSIONS: Both standard and minimally invasive PCNL have shown good outcomes in the treatment of symptomatic renal stones between 20-40 mm. Although the success rates are similar for both techniques, hospitalisation time, bleeding and transfusion rates are in favor of mPCNL. With the availability of high energy Holmium lasers, even a high stone burden is amenable to mini-PCNL. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e477 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aymen Sakly More articles by this author Walid Zakhama More articles by this author Nejm Jleli More articles by this author Aymen Mnasser More articles by this author Yassine Binous More articles by this author Expand All Advertisement PDF downloadLoading ...

MP70-19 PREDICTORS OF FOLLOW-UP OF PEDIATRIC STONE PATIENTS AFTER SURGICAL INTERVENTION

You have accessJournal of UrologyCME1 Apr 2023MP70-19 PREDICTORS OF FOLLOW-UP OF PEDIATRIC STONE PATIENTS AFTER SURGICAL INTERVENTION Megan Stout, Nora Thompson, Jason Benedict, Seth Alpert, Daniel Dajusta, Molly Fuchs, Rama Jayanthi, Daryl Mcleod, and Christina Ching Megan StoutMegan Stout More articles by this author , Nora ThompsonNora Thompson More articles by this author , Jason BenedictJason Benedict More articles by this author , Seth AlpertSeth Alpert More articles by this author , Daniel DajustaDaniel Dajusta More articles by this author , Molly FuchsMolly Fuchs More articles by this author , Rama JayanthiRama Jayanthi More articles by this author , Daryl McleodDaryl Mcleod More articles by this author , and Christina ChingChristina Ching More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While studies in adult kidney stone patients have found social and demographic factors influence medical compliance, there is limited data in the pediatric patient population. We investigated if socioeconomic and demographic factors predict post-surgical follow-up in pediatric stone patients. METHODS: All patients having kidney stone surgery at a single academic pediatric hospital over a 5 year period (January 2016 - December 2020) were identified through the use of CPT codes specific to ureteroscopy, shock wave lithotripsy, and percutaneous nephrolithotomy. Electronic charts were reviewed for patient demographics and social factors. For each discrete stone episode (defined as care for a stone within a 6 month window), patient presentation, stone characteristics, and characteristics of intervention were also collected. Appropriate follow-up compliance was reported as having a scheduled and attended provider visit within 6 months after last discrete stone episode surgery. Univariable analyses were performed to test for factors associated with follow-up using Fisher’s exact test for categorical variables and Wilcoxon rank-sum test for continuous variables. RESULTS: 271 pediatric patients, a median age of 16.0 years (IQR 12.0, 18.0) at surgery, were identified. The majority were non-Hispanic white (90%) and female (62%). Most had undergone ureteroscopy (86%). In general, almost all had a postoperative provider visit scheduled after surgery (260; 96%), with 194 (75%) attending that visit. The attached table demonstrates metrics compared between groups that were compliant with follow-up and those that were not (Table 1). Factors associated with lack of follow-up were having public insurance and being from single-parent homes (p<0.001). Patients with a prior urology clinic visit and those living farther away were more compliant with follow-up (p<0.05). CONCLUSIONS: Kidney stone disease is not benign and surgery is not without risk; follow-up compliance remains of critical importance. We identified public insurance as well as single parenthood to be potential predictors of pediatric follow-up compliance. Identifying factors that may predict non-compliance could be used to help at-risk patient populations. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1011 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Megan Stout More articles by this author Nora Thompson More articles by this author Jason Benedict More articles by this author Seth Alpert More articles by this author Daniel Dajusta More articles by this author Molly Fuchs More articles by this author Rama Jayanthi More articles by this author Daryl Mcleod More articles by this author Christina Ching More articles by this author Expand All Advertisement PDF downloadLoading ...

WCN23-1199 Urinary stones in pediatric patients; a treatment challenge

WCN23-1199 Urinary stones in pediatric patients; a treatment challenge

Medical Expulsive Therapy for Pediatric Ureteral Stones: A Meta-Analysis of Randomized Clinical Trials

To evaluate the efficacy and safety of medical expulsive therapy (MET) for ureteral stones in pediatric patients, Cochrane, PubMed, Web of Science, Scopus, and the reference list of retrieved studies were searched up to September 2022 to identify RCTs on the efficacy of MET. The protocol was prospectively registered at PROSPERO (CRD42022339093). Articles were reviewed, data were extracted by two reviewers, and the differences were resolved by the third reviewer. The risk of bias was assessed using the RoB2. The outcomes, including the stone expulsion rate (SER), stone expulsion time (SET), episode of pain, analgesic consumption, and adverse effects, were evaluated. Six RCTs enrolling 415 patients were included in the meta-analysis. The duration of MET ranged from 19 to 28 days. The investigated medications included tamsulosin, silodosin, and doxazosin. The stone-free rate after 4 weeks in the MET group was 1.42 times that of the control group (RR: 1.42; 95% CI: 1.26-1.61, p < 0.001). The stone expulsion time also decreased by an average of 5.18 days (95% CI: -8.46/-1.89, p = 0.002). Adverse effects were more commonly observed in the MET group (RR: 2.18; 95% CI: 1.28-3.69, p = 0.004). The subgroup analysis evaluating the influence of the type of medication, the stone size, and the age of patients failed to reveal any impact of the aforementioned factors on the stone expulsion rate or stone expulsion time. Alpha-blockers as medical expulsive therapy among pediatric patients are efficient and safe. They increase the stone expulsion rate and decrease the stone expulsion time; however, this included a higher rate of adverse effects, which include headache, dizziness, or nasal congestion.

The Effectiveness and Safety of Percutaneous Cystolithotripsy for Vesicle Calculus in Children: A Single-Center Study

Background: Primary bladder stones are common among children from developing countries but may be difficult to cure. Transurethral cystolithotripsy, open cystolithotomy, and shock wave lithotripsy are the treatment modalities for vesical calculi in children. Transurethral lithotripsy is less efficient in children because of the small caliber of the urethra. PCCL is a less intrusive and efficient procedure for removing bladder stones in pediatric patients. Objectives: The objective of the study was to determine the safety and efficacy of PCCL in children with bladder stones in third-world nations. Materials and Methods: There was a search for( PCCL) in pediatric individuals diagnosed with vesical calculus. 90% male and 10% female total of 120 patients enrolled in the single-center trial at the Department of Pediatric Urology at the Institute of Kidney Diseases between January 2021 to January 2022. The surgery was performed under a general anesthetic. After a thorough inspection, a suprapubic puncture of the lower urinary tract (by cystoscopy) was done. The tract was only dilated up to 14 Fr. The stone was fragmented using pneumatic lithotripsy after passing the nephroscope. After 36 hours per urethral catheter was removed. Results: In this study, the mean age of the patients was 4.2.14 years. The majority of patients were kids. The average gem was 9.3 millimeters in diameter. Successful stone fragmentation and retrieval took place in an average of 40 min. The only major problems seen during or after surgery were hematuria, infection, and moderate mucosal injury; all three were managed conservatively. In 108 out of 120 cases (90%), ammonium acid urate was found to be the primary constituent of the stones and the core. Conclusion: The success rate of percutaneous cystolithotripsy in the treatment of bladder stones in children is higher, and it is ready for immediate use. The operation is quick and causes minimal discomfort. Keywords: Effectiveness, Percutaneous , Cystolithotripsy, Vesical Calculus, Children

Extracorporeal shock wave lithotripsy for urinary tract stones in pediatric patients: Our 11 years of experience

Background/Aim: Urinary system stone disease creates a significant burden on the health system. Many treatment methods are available, including extracorporeal shock wave lithotripsy (ESWL), endourological procedures, and open and laparoscopic procedures. In recent years, in parallel with technological developments, endourological devices have become more usable in the renal system. For this reason, urologists are opting for endourological procedures more frequently. ESWL is the least invasive procedure for urinary system stone disease, and it has a higher success rate in pediatric patients than in adults. In this retrospective cohort study, we analyzed the data from the pediatric cases in which we used ESWL treatment in our clinic. We aimed to reveal the effectiveness of ESWL and the factors that will increase the success rate of this procedure in light of the current literature. Methods: The files of patients aged 16 years and under who underwent ESWL at the Urology Clinic of University of Health Sciences Sanliurfa Mehmet Akif Inan Training and Research Hospital between January 2010 and December 2021 were retrospectively reviewed. Age, gender, stone area, stone localization, number of sessions, energy and frequency used, complete stone-free status, and secondary intervention requirement were recorded. The absence of stone fragments or the presence of fragments smaller than 3 mm only in imaging after ESWL was considered a success. Results: This study included 433 pediatric patients. The mean age of the patients was calculated as 12.02 (4.67) (range: 1–16) years. The most important factors affecting the number of residual stones were stone localization (P = 0.045) and size (P &lt; 0.001). When stone localization was compared according to patient age, the older patients were found to have a significantly higher rate of stones in the proximal ureter than in the lower calyx of the kidney (P = 0.045) and renal pelvis (P = 0.048). Conclusion: Although there are continual advances in other minimally invasive surgical methods today, ESWL is a treatment method that can be safely applied in pediatric patients. Stone size and stone localization are the two most important factors affecting its success rate.

Retrorenal colon in pediatric patients with urolithiasis: Is the supine position for PCNL advantageous?

Percutaneous nephrolithotomy (PCNL) is one of the main approaches for the treatment of large and complex stones in pediatric patients. The patient position for PCNL has been classically divided into prone or supine and the prone position is more commonly used. One of the most feared complications of this surgical technique is colon injury and the objective of this work is to evaluate the incidence of retrorenal colon (RRC) both supine and prone position, in pediatric patients, through radiological images. A retrosepctive review was performed of all abdominal CT scans performed in one center, in patients under 18 years since 2017 to 2019. The ideal path for percutaneous puncture was traced in the upper, middle, and lower calyces of both kidneys in the prone and supine positions and contact with the kidney and adjacent organs was evaluated, with a uro-radiologist. Chi-square test and Student's t test were applied. 50 CT-scans were performed on 44 children. Patients had a mean age of 12.6 years and 71.4% were male. Twenty-five scans were performed in the prone and 25 in the supine position. The incidence of RRC for the left kidney (LK) was significantly higher in the lower calyx in prone position than in the supine position, 28% vs 4% (p=0.049), and the right kidney (RK) presented RRC only in the prone position. The liver was the most frequent retrorenal organ (97.7%) for the RK, with a non-significant difference by position, while for the LK the spleen was the most frequent (61.1%). Colon injury is one of the most morbid complication in PCNL and one of the reasons to perform a CT scan before surgery, on which its incidence appears to be <1% in adults. The present study revealed RRC to be present in three (12%) patients in the supine position and seven (28%) patients in the prone position (p=0.15). These results were slightly higher from those reported in adults (supine: 1.7%-10%; prone: 6.8%-20%), but there are no reports in the literature on this issue to allow appropriate comparison. This is the first study to attempt to assess the incidence of RRC in children according to position. The incidence of RRC for an ideal puncture was significantly higher in the lower calyx of the left kidney in the prone position than in the supine position, and in the right kidney, the RRC only occurred in the prone position.

A0780 - The efficacy and safety of RIRS in the surgical treatment of kidney stones in pediatric patients from a single pediatric urology center

A0780 - The efficacy and safety of RIRS in the surgical treatment of kidney stones in pediatric patients from a single pediatric urology center

V61 - Semi-closed-circuit vacuum-assisted Mini-PCNL system for renal stones in pediatric patients: The experience by a tertiary referral center

V61 - Semi-closed-circuit vacuum-assisted Mini-PCNL system for renal stones in pediatric patients: The experience by a tertiary referral center

Ceftriaxone-Induced Gallbladder Stones in Children

Gallbladder stones in children is one complication that is mostly seen in diseases such as hemolytic diseases, liver disease, and obesity. It can also be a secondary complication of long-duration use of antibiotics like ceftriaxone. However, gallbladder stone, together with sludge themselves, is unusual within the children's population. We observed three children with gallbladder stones who were on along course of intravenous ceftriaxone. In this study, we present the three cases of children aged between eleven months to seven years who were treated with high doses and for an extended period (more than two weeks) of intravenous ceftriaxone for a complicated systemic bacterial infection. The goal of this study is to raise awareness about the possibility of developing gallbladder stones in pediatric patients who receive a long course of intravenous ceftriaxone.