ESPU Meeting on Saturday 27, April 2019, 10:46 - 11:22
Burak ÖZÇİFT 1 and Hüseyin Tuğrul TİRYAKİ 2
1) Health Sciences University, Izmir Dr. Behcet Uz Child Diseases and Surgery Training and Researching Hospital, Pediatric Urology Unit, Izmir, TURKEY - 2) Health Sciences University, Ankara Child Health and Diseases Hematology Oncology Training and Researching Hospital, Department of Pediatric Urology, Ankara, TURKEY
Miniaturized percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are generally used for pediatric kidney stones; however, comparative study of these methods are not enough. We aimed to compare our outcomes of mini-PCNL and RIRS for treatment of 10 mm to 20 mm size kidney stones in children.
MATERIAL AND METHODS
Pediatric patients who underwent mini-PCNL (n=24) and RIRS (n=29) with kidney stones for 10 to 20 mm in size were compared retrospectively. Patients’ gender, age, body mass index (BMI), stone laterality, stone size, stone location, operative and postoperative outcomes were reviewed in both groups.
The mean age was 7.43±5.13 years (1-15.7 years) in the mini-PCNL group and 5.18 ±3.96 years (0.6-13.7 years) in the RIRS group (p=0.07). The mean BMI, mean stone size and gender were similar between the both groups. The stone-free rate (SFR) was 79.2% in the mini-PCNL group and 65.5% in the RIRS group after a single procedure (p=0.27). The overall SFRs increased to 91.7% and 89.7% with additional therapies for mini-PCNL and RIRS, respectively (p=0.80). The mean hospitalization, operation and fluoroscopy times were statistically longer in the mini-PCNL group. The mean number of anesthesia requiring intervention related to passive dilation, JJ stent removal and re-treatment was 1.12 ± 0.33 in the mini-PCNL group and 2.06 ± 0.37 in the RIRS group (p=0.00). Minor complication rates were 20.8% and 6.9% in the mini-PCNL and RIRS group, respectively (p =0.13). There was no major complication observed in both groups
This study suggested that RIRS is an effective alternative to mini-PCNL for 10 to 20 mm in size kidney stones in children, with comparable success and complication rates. Patients and their parents should be informed about the alternative available kidney stones treatment options.
Wenying WANG and Jun LI
Beijing Friendship Hospital, Capital Medical University, Urology, Beijing, CHINA
To compare the effects of micro-percutaneous nephrolithotomy (micro-PCNL) and flexible ureteroscopic lithotripsy (FUL) in treating 1-2 cm solitary renal stones in infants.
MATERIAL AND METHODS
A retrospective analysis was performed on data from 57 infants who received micro-PCNL and FUL surgery in our hospital from October 2016 to May 2018. The patients were divided into group 1—micro-PCNL group and group 2—FUL group. Perioperative data, including surgical time, blood loss, stone free rate, and complications, were analyzed.
There were 27 patients in group 1 and 30 patients in group 2, and the patients' mean age was 19 and 21 months respectively. The average stone size was 1.6±0.3 cm in group 1 and 1.7±0.2 cm in group 2; the mean surgical time was 21±4 min and 23±5 min; and the stone free rate at 1 month after surgery were 88.9% and 86.7%, respectively. The average number of anesthesia sessions for patients was 1.4 in group 1 and 2.7 in group 2. The complication rate was 14.8% and 16.7%, respectively. None of the patients needed conversion to the 12-14F mini-PCNL.
The results of this study showed that the surgical effects and complications of micro-PCNL and FUL in treating infants with 1-2 cm solitary renal stones were similar. However, micro-PCNL allowed lower anesthesia sessions. Therefore, micro-PCNL is an effective, alternative method for 1-2 cm solitary renal stones in infants.
Sherjeel SAULAT 1, Murtaza AZAD 2, Anees Ur Rehman SOOMRO 2, Saeed QADRI 2 and Faraz KHALID 2
1) Tabba Kidney institute, Paediatric Urology, Karachi, PAKISTAN - 2) TABBA KIDNEY INSTITUTE, PAEDIATRIC UROLOGY, Karachi, PAKISTAN
The purpose of this study is to analyze the success and complication rates of PCNL in different age groups of children and to compare the outcomes of the respective groups of patients in order to identify the efficacy of PCNL according to age groups.
MATERIAL AND METHODS
The data was collected retrospectively from patient's records ( from November 2014 to September 2018. Patient's data including age, gender, stone burden, hemoglobin drop, operative time, complications and hospital stay duration were documented. Successful outcome was a stone free renal unit on postoperative USG KUB. Chi-Square and Kruskal Wallis tests were applied to observe any association of variables with different age groups. p Value ≤ 0.05 was considered significant.
There were total 357 children enrolled in our study in which 238 (66.7%) were male while 119 (33.3%) were female. We divided patients in three groups according to their age. The overall mean age was 8+- 1.6. In Group-1 (0-5 years of age) 137 (38.4%) patient were recruited. 109 (30.5%) children were in Group-2 (6-10 years of age) while 111 (31.1%) were in Group-3 (11-15 years of age).
Comparison of continuous lab, clinical and stone parameters was carried out between three age groups and found that almost all variables were significantly different between age groups. Association of Categorical Variables with age group was observed and which showed that site of puncture, family history of stone, complete stone free rate were significantly associated with different age groups.
The overall stone free rate was 84.6%. The best stone free rate came for the youngest Group 1 96.4% and the least for eldest Group 3 as 68.5%.
PCNL is a more efficient and safe procedure for the infants and toddlers than for the older age groups of children.
Bashir AHMED 1 and Sajid SULTAN 2
1) Sindh Institute of Urology & transplantation, Philips Rensley Department of Paediatric urology, Karachi, PAKISTAN - 2) Sindh institiute of urology and transplanation, Philps Rensely department of paediatric urology and transplantation, Karachi, PAKISTAN
To compare the safety, efficacy and outcome (stone clearance and complications) of Pneumatic lithoclast VS Holmium YAG Lasertripsy for renal calculi in children.
MATERIAL AND METHODS
Records of children managed by MINI PCNL (Sheath upto 16 Fr) in 132 renal units using Holmium YAG Lasertripsy (LL) and Pneumatic lithoclast (PL) performed between Jan and Dec 2017 were reviewed for age, gender, stone size, duration of procedure, outcome in term of stone clearance and complications. Amplatz sheath upto 16 Fr, paediatric cystoscope and nephroscopes 6/7.5Fr and 12 to 15Fr were used according to the size of the patient, stone location and disintegration technology used.
Of the 132 renal units 84 were managed by Ho-YAG lasertripsy and 48 by pneumatic lithoclast. Mean age and gender ratio in two groups were comparable 5.7+3.5 VS 6.26+3.6 (p=0.3) and 2.1:1 VS 1.27:1 (p=0.1) from laser VS pneumatic lithoclast respectively. The mean stone volume (cm2) and mean operating time were also comparable 1.88+1.1 VS 1.87+1.0 (p=0.9) and 110+40 VS 105+46 (p=0.5) respectively. The stone clearance was complete clearance 84.5% VS 81% (p=0.4). The complication in Ho- YAG lastripsy was 15.8% VS 16.2% in pneumatic lithoclast. Blood transfusion requirement were also comparable 10.4% VS 112%.
There was excellent stone clearance with both the modalities with acceptable complication rates.
Burak CITAMAK 1, Hasan Serkan DOGAN 1, Taner CEYLAN 1, Berk HAZIR 1, Cenk Yucel BILEN 1, Ahmet SAHIN 2 and Serdar TEKGÜL 1
1) Hacettepe University, Urology, Ankara, TURKEY - 2) Acıbadem University, Urology, Istanbul, TURKEY
To develop a scoring system that predicts preoperative success of percutaneous nephrolithotomy (PCNL) in children.
MATERIAL AND METHODS
A retrospective analysis was conducted on data from 434 renal units belonging to kidney stone patients who underwent PCNL between 1997 and 2017. Stone kidney index (SKI) was calculated by dividing the length of the stone along its longest axis by the length of the kidney along its longest axis. Factors that predicted success and complications were examined by univariate and multivariate analyses.
Mean age was 8.3 (1-16) years, and male to female ratio was 236:165. Average stone length and kidney length were 2.41 (0.4-10) cm and 8.5 (6.23-10.93) cm, respectively. When stone-free patients were compared to other patients, there was a statistically significant difference in average SKI (0.266 vs 0.339, p < 0.001). In multivariate analysis, factors that predicted success were SKI and the number of stones. The stone-kidney score (SKS) was formed by the sum of points given for SKI (1: SKI<0.3, 2: SKI>0.3) and the number of stones (1: single, 2: multiple) into one value. Success rates for SKS scores of 2, 3, and 4 were 86.4%, 73%, and 62.9% (p < 0.001), respectively. Complication rates for SKS scores of 2, 3, and 4 were 13%, 22.1%, 23.8%, respectively.
When evaluated together, SKI and presence of multiple stones may predict stone-free rates preoperatively. SKS is an individual-specific method that can be easily used in pediatric clinical practice. Further studies are required to develop and standardize this method.
Perviz HAJIYEV 1, Aykut AKINCI 2, Cagri AKPINAR 1, Muammer BABAYIGIT 2, Mehmet Ilker GÖKCE 2, Tarkan SOYGUR 1 and Berk BURGU 1
1) Ankara University School of Medicine, Pediatric Urology, Ankara, TURKEY - 2) Ankara University School of Medicine, Urology, Ankara, TURKEY
The aim of the study is to assess the success of mini percutaneous nephrolitectomy in supine position alone or combined with flexible ureterorenoscopy which we recently adopted as our routine in recent 2 years and compare this with our most recent 3 year results of previous routine prone position.
MATERIAL AND METHODS
We retrospectively analyzed the results of our mini percutaneous nephrolithotomies (12-16 Fr) performed in children with a mean age 9.5 years (10 months to 16 years) of age in our department between 2013-2016 for prone and 2016-2018 for supine. We compared, stone-free rates, mean operative time, duration of fluoroscopy and hospitalization and complication rates.
The data of 57 patients underwent pnl in a 56 months period using mini-perc procedures were analyzed. 36 children underwent prone and 21 children underwent supine pnl procedures.
Both the groups were comparable for preoperative parameters. The mean stone size was 16 (12–32) mm. The mean operating time was statistically significantly longer in prone [75± 20 min] as compared to supine [61.2±20, ]. Whereas the duration of fluoroscopy were similar. After the first session of PCNL the SFR for supine was 91.2 % and for prone 92.5 %, which was not significantly different. 6 patients had simultaneous RIRS in supine group. Postoperative fever occurred in 5 patients (in prone 3 and in supine 2 p.) No difference was observed between the positions with regard to the hospital stay and complications.
As experienced prone miniperc surgeons we believe conversion to Supine as routine procedure is easy thus supine mini-perc offers similar outcomes with even shorter operation time compared to the prone position.