ESPU Meeting on Saturday 27, April 2019, 11:22 - 11:42
Hasan Serkan DOĞAN, Oğuzhan KAHRAMAN, Tariq Jamal ASI, Hakan Bahadır HABERAL and Serdar TEKGÜL
Hacettepe University Faculty of Medicine, Department of Urology, Ankara, TURKEY
To compare treatment of childhood stone disease with retrograde intrarenal surgery (RIRS) vs micro-percutaneous nephrolithotomy (micro-PNL).
MATERIAL AND METHODS
Between June 2016 and June 2018, children who had single renal stone, less than 20 mm, were prospectively randomised with envelope method to RIRS and micro-PNL groups were compared. For RIRS 4,9 F flexible ureteroscope and for micro-PNL 4,8 F micro-percutaneous nephrolitotomy device were used. Stone free rates, efficiency coefficient (EC= stone free patients/operations under general anesthesia) and complications were evaluated. 3 mm and less residues were evaluated as clinically insignificant residue and above 3 mm accepted as fail.
22 patients were randomised to RIRS, 18 patients were randomised to micro-PNL group.
Considering the patients who had to be changed from the first plan and took alternative treatment, RIRS was performed to 19 patients and micro-PNL was performed to 21 patients.
Pelvis localization was more, patient age was younger, stone size was bigger, Hounsfield unit (HU) was bigger and operation time was longer in micro-PNL group. Pre- and postoperative hemoglobin (Hb) values were statistically different in micro-PNL group (Pre-operative Hb 12,2±1,6, Post-operative Hb 11,8±1,2, Paired sample T test: 0,031). But there was no need for blood transfusion.
|RIRS (n=16)||micro-PNL (n=19)||p|
|Pelvis/other than pelvis||2/14||11/8||0,012 (x2)|
|Stone size,mm,median,min-max||6 (3-18)||11 (5-16)||0,014 (MWU)|
|HU, median, min-max||655 (205-1150)||996 (625-1848)||0,011 (MWU)|
|Operation time, min., mean±SD||48±25||80±32||0,03 (T-test)|
*P:Pelvis,U:Upper pole,M: Middle,L: Lower pole
Single, less than 20 mm stones can be treated with RIRS and micro-PNL with similar efficiacy and complication rates in childhood stone disease. In terms of stone localization and size, more similar and larger groups of research are needed.
Ruben ORTIZ, Laura BURGOS, Alberto PARENTE and Jose Maria ANGULO
UNIVERSITY HOSPITAL GREGORIO MARAÑON, MADRID, SPAIN., PEDIATRIC UROLOGY, Madrid, SPAIN
Compare long-term effectiveness, complications and outcomes of endoscopic balloon dilation (EBD) of primary obstructive megaureter (POM) treated under the original technique with fluoroscopic vision VS not radioscopic guidance during the procedure.
MATERIAL AND METHODS
A comparative study was conducted to compare POM cases treated by endoscopic balloon dilation under fluoroscopic guidance (FG) vs no-fluoroscopic control (NF) between years 2004-2016. From 2004 to 2011 (n=43) POM were treated with the original technique. It consisted on performing a retrograde pyelography before dilation, then a guide-wire is introduced up to the renal pelvis and the EBD of the vesicoureteral junction is performed using high-pressure balloon catheters (2.7FG) with balloon diameter 5-7mm under fluoroscopic vision. Finally a double J stent is placed between renal pelvis and bladder. Since 2011, (n=36) cases underwent the procedure with no radiological exposure, only under cystoscopic vision leaving double-j stents on the dilated ureter instead. Follow-up protocol included periodical clinical reviews, US and MAG-3 renogram scans.
Improvement in renal drainage was observed on the MAG-3 diuretic renogram after endoscopic treatment in both groups (T1/2> 50 min vs 10.4±4 min FG, p<0.001 T-test); (T1/2> 50 min vs 10.3±5 min NF, p<0.001 T-test), with no differences between them (p>0.05). Both groups showed significant pre/postoperative differences in hydronephrosis grade and ureteral diameter that were maintained in long-term (p<0.001 T-test). Statistical analysis did not revealed differences between groups in initial technical failure (r:-0.021 p>0.05), early postoperative complications (r:-0.028 p>0.05), secondary VUR (r: 0.052 p>0.05), re-stenosis (r: 0.011 p>0.05), long-term ureteral reimplantation (r: 0.032 p>0.05) and final outcome (r:-0.043 p>0.05). Endoscopic treatment of POM had a long-term success rate of 37/43 (86.5%) in FG with a mean follow-up of 10.5±2.2 years; and 32/36 (88.8%) in NF with follow-up of 4.8±1.3 years.
EBD has shown to be a valid option for the treatment of POM. This procedure could be done radiation free with similar results, effectiveness and outcomes than original endoscopic technique
Marc CHALHOUB, Jules KOHAUT, Nathalie BOTTO, Yves AIGRAIN, Henri LOTTMANN and Thomas BLANC
Hôpital Necker - Enfants Malades, Department of Pediatric Surgery and Urology, Paris, FRANCE
The 3 most common reasons to leave a Double-J ureteral stent (DJUS) are to ensure urinary diversion, maintain ureteral calibre and maintain anastomotic alignment.
In the adult population, a DJUS can be removed at the clinic under direct vision by flexible cystoscopy.
In contrast, DJUS removal in children requires a second general anaesthetic and cystoscopy.
Our aim is to report the use of Black-Star® and magnetic retrieval device in the paediatric population.
MATERIAL AND METHODS
The Black-Star® (Urotech [Achenmühle, Germany]) is a 4.8Fr ureteral stent (length 10-24 cm) with a 7Fr magnet fixed with a string at the distal DJUS loop. To remove the DJUS, a customised catheter like retrieval device, lubricated with 2% lidocaine jelly, with a magnetic Tiemann tip is inserted. Both indwelling magnets connect and the catheter can be removed together with the DJUS.
A total of 47 Black-Star® were placed during robotic pyeloplasty in an antegrade fashion (n=25), open procedure (renal transplant n=13, ureteric reimplantation n=7) or cystoscopy retrograde placement (n=2).
We retrospectively reviewed patient medical files over a 2-year period
Mean age was 9 years (0,9-18) and mean weight was 30 kg (8-62).
In 9/25 cases of antegrade stenting (36%), the Black-Star® could not traverse the ureterovesical junction.
Stents were left indwelling for a mean of 32 days (10-129).
The Black-Star® could be successfully removed in the out‐patient clinic with the retrieval device in 35 out of 38 patients without needing endoscopy. For the other three patients, removal by cystoscopy was needed.
The Black-Star® and its magnetic retrieval device can be safely used in paediatric patients permitting outpatient awake removal of the stent and thus reducing anaesthetic-associated morbidity. The development of a smaller magnet is needed to pass the ureterovesical junction in children. Cost effective analysis is in progress.