5th Joint Meeting of ESPU-SPU - Virtual

S23: STONES 2 (parallel session, room 2)

Moderators: Ana Bujons (Spain)

ESPU-SPU Meeting on Saturday 25, September 2021, 16:05 - 16:47


16:05 - 16:08
S23-1 (PP)

IS RETRORENAL COLON A FACTOR TO CONSIDER FOR THE SUPINE PCNL APPROACH IN THE PEDIATRIC POPULATION?

Yesica QUIROZ MADARRIAGA 1, Esteban EMILIANI 2, Erika LLORENS DE KNECHT 1, Daniela VILLADA FLOREZ 1, Guilherme MOTTA LANG 1, Claudia QUINTIAN SCHWIETERS 3 and Anna BUJONS 1
1) Fundacio Puigvert, Paediatric Urology, Barcelona, SPAIN - 2) Fundacio Puigvert, Urolithiasis, Barcelona, SPAIN - 3) Fundacio Puigvert, Radiology, Barcelona, SPAIN

PURPOSE

PCNL has become one of the main approaches in complex stones, but the most severe complication is colonic perforation. The aim of this study is to evaluate the incidence of retrorenal colon (RRC) in CT scans of pediatric patients, regarding their position to evaluate which may be safest way to puncture the kidney.

MATERIAL AND METHODS

Prospective review of 50 CT scans in 44 patients aged under 18-years-old was performed: 25 in supine and 25 in prone position. The mean age was 12.6 years and 71.4% were male. All scans were performed in the same center and the measurements were made in the axial plane with the guidance of the sagittal and coronal planes. The ideal theoretical path for percutaneous puncture was traced through the posterior calyx of upper/mid/lower poles of both kidneys in prone and supine decubitus, the contact with kidney and/or adjacent organs was evaluated.

RESULTS

The retrorenal colon (RRC) incidence for the inferior calix of left kidney (LK) was significantly higher in prone position compared to supine position: 28 vs 4% respectively (p = 0.049), while in the right kidney (RK) it only appeared in prone (4%). The RRC in the upper and mid left calyces puncture have a tendency, not statistically significant, of being higher in prone than in supine. The liver was the most frequent retrorenal organ (97.7%) for the RK with a non-significant difference by position and the spleen was the most common (61.1%) for the LK. The maximum access angle in the RK was greater in the prone position, but in the LK was in supine, without significant difference.

CONCLUSIONS

The incidence of RRC seems to be lower in the supine position, demonstrating that this position is safer for the percutaneous approach of stones in children.


16:08 - 16:11
S23-2 (PP)

PERCUTANEOUS NEPHROLITHOTOMY (PCNL) FOR INFANT VERSUS ADOLESCENT STAGHORN CALCULI: A COMPARATIVE STUDY

May BISHARAT 1, Alex CHO 2, Wesley HAYES 3, William VAN'T HOFF 4, Simon CHOONG 5, Alex BARNACLE 6 and Naima SMEULDERS 2
1) Great Ormond Street Hospital, Paediatric urology, London, UNITED KINGDOM - 2) Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH., Paediatric urology, London, UNITED KINGDOM - 3) Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH., Paediatric nephrology, London, UNITED KINGDOM - 4) Paediatric nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH., London, UNITED KINGDOM - 5) Departments of Paediatric Urology1, Nephrology2 and Interventional Radiology3, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH., Urology, London, UNITED KINGDOM - 6) Departments of Paediatric Urology1, Nephrology2 and Interventional Radiology3, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH., Interventional radiology, London, UNITED KINGDOM

PURPOSE

PCNL is the gold standard procedure for Staghorn calculi. We hypothesize that infant kidneys are more malleable, requiring less tracts for stone clearance. We compare PCNL for Staghorn stones in children aged 0-3yrs and 13-16yrs. 

MATERIAL AND METHODS

With institutional approval, data of children aged 0-3yrs and 13-16yrs undergoing PCNL at our institution between November 2009 and October 2019 were reviewed from our prospective procedural database. Statistical analysis was performed using chi-squared test. 

RESULTS

The infant (19 renal units) and adolescent (16 renal units) groups underwent 22 PCNL procedures each for Staghorn calculi of similar complexity (partial:1vs2; complete:17vs15; complicated 4vs5), although cumulative diameter was greater in adolescents. Infants all had a single tract, while adolescents had 18-single, 2-double, 1-triple and 1-quadruple tracts(p=0.031). Stone free rate(SFR) after first PCNL was 86.3% and 81.8% for infants and adolescents, respectively(p=0.6). Operative time was significantly longer in adolescents(p=0.003),as was the need for further PCNL(p=0.028). See Table 1 for further details.

 

Range(median)

Infants 

(n=19)

Adolescents

(n=16) 

Chi-squared 

Age 

0.9-2.8yrs(1.7yrs)

13.0-15.8yrs(14.3yrs)

M:F

15:4

7:9

Weight 

8.0-14.2kg(11.7kg)

34.4-101kg(60.2kg)

PCNL:

Staged-PCNL

Recurrent stones

 

Total multiple-PCNL

22 in 19

2 in 2    

1 in 1

 

3/19(15.7%)

22 in 16

5 in 3

1 in 1 

 

6/16(31.25%)

 

 

 

 

p=0.028

Staghorn:

partial

complete

complicated

 

1

17

4

 

2

15

5

Stone-burden

14-49mm(24.9mm)

16-88mm(41.7mm)

p=0.005

Multiple-tracts 

0/22(0%)

4/22(18%)

p=0.031

Operative-time 

90-180min(132min)

135-350min(192min)

p=0.003

Complications 

2/22(9%)

4/22(18%)

p=0.37

SFR after PCNL

19/22(86.3%)

18/22(81.8%)

p=0.6

Ancillary ESWL

4/22(18.1%)

8/22(36.4%)

p=0.18

Overall SFR

22/22(100%)

20/22(90.9%)

p=0.15

Table 1

CONCLUSIONS

This study confirms that PCNL for Staghorn stones is more straight-forward in infants as compared to adolescents despite similar complexity of calculi. 


16:11 - 16:14
S23-3 (PP)

ENDOSCOPIC TREATMENT OF STONES IN AUGMENTED BLADDER WITH MITROFANOFF IN CHILDREN: WHAT IS THE BEST APPROACH?

Ahmed FAHMY, Mohamed YOUSSIF, Walid DAWOOD, Haytham BADAWY and Ibrahim ALHENNAWY
Alexandria Faculty of Medicine, Urology Department, Alexandria, EGYPT

PURPOSE

Bladder stones after bladder augmentation and Mitroffanof are frequently encoutered problem which pose a challenge to treating physican especially in the setting of bladder neck reconstruction or closure. Herein, we compare two endoscopic approaches either transmitrofanoff endoscopic fragmentation and stone extraction or percutaneous suprapubic fragmentation and extraction for treating bladder stones after urinary construction.

MATERIAL AND METHODS

Fifty four children with bladder stones after augmentation and Mitroffanof underwent endoscopic treatment during the period from 2015-1019.They were randomly assigned into two equal groups; group 1 included 27 patients who underwent Mitrofanoff cystolitholapaxy and group 2 underwent percutaneous suprapubic cystolithotripsy. We compare success rate of both procedure and early and delayed complications associated with both approaches.

RESULTS

Complete stone clearance was achieve in 88.8 % and 100% in group 1 and 2 respectively. There were no immediate complications in both groups.
Two patients in group 1 had persistent leakage, one of which needed surgical revision. Four patient had difficulties catheterization the channel on follow-up in the group 1. None of these complications ocured in group 2.
Stone recurrence occurred in 6 and 2 patients in group 1 and 2 respectively. Mean time to recurrence was 14 months (range 5-36 months).

CONCLUSIONS

Both approaches were safe and effective in removing stones from bladder after urinary reconstruction. No derrangement of Mitrofanoff continence mechanism and less rate of stone recurrence was associated with percutaneous suprapubic approach.


16:14 - 16:17
S23-4 (PP)

PREDICTION OF STONE-FREE STATUS AFTER SINGLE-SESSION RETROGRADE INTRARENAL SURGERY IN PEDIATRIC POPULATION

Lucia MOSQUERA 1, Yesica Yasmin QUIROZ MADARRIAGA 2, Alejandra BRAVO BALADO 1, Erika LLORENS DE KNECHT 1, Laia SABIOTE 1 and Anna BUJONS TUR 1
1) Fundacio Puigvert, Pediatric Urology, Barcelona, SPAIN - 2) Fundacio Puigvert, Paediatric Urology, Barcelona, SPAIN

PURPOSE

Retrograde intrarenal surgery (RIRS) is the election treatment in multiples stones scenarios in adults, however in children is not so widely used. Our aim is determine the possible factors effecting stone-free status (SFS) after single-session retrograde intrarenal surgery (RIRS) for renal stones

MATERIAL AND METHODS

We analyzed prospectively data of 55 RIRS in 39 children (51,3% female, main age 12 years) in a period of 4 years. Patient demographics, BMI, urological malformations, recurrent UTIs hydronephrosis, urine pH, location, number and size of stones, presurgical double J stent (JJ), surgical time, ureteral sheet, SFR and complications were analyzed and reported. We performed multivariate logistic regression.

RESULTS

Median BMI was 18,9 and 36,4% of the patients had urological malformations, 58,2% had previus stone treatment y 41,8% had JJ, but either of this factors presented significant association with SFR. Median stone diameter was 9mm(IQR7-13), the most frecuent location was calicilar (49,1%) and 58,2% were mutiple. The median surgical time was 111 minutes and the median hospital stay was 2 days. Regarding the composition of the stones, 36,4% were made of calcium oxalate, followed by calcium phosphate (20%), but did not had significant assosiation with SFR. The SFR of the single-session of RIRS was 52,7% and in the bivariate analysis surgical time, multiple (>3) and complex stones were statistically significant, but in the multivariate analysis only the number of stone was significat (OR11,26 IC95%1,11-112,9, p=0,04).

CONCLUSIONS

The factor more reliable in predicting single-session RIRS success is the number of stones and the characteristics of the stone like their complexity maybe can use in future nomograms. This is the first study of predicting factors in pediatric RIRS.


16:17 - 16:29
Discussion
 

16:29 - 16:32
S23-5 (PP)

FACTORS AFFECTING SUCCESS RATES OF RETROGRADE INTRARENAL SURGERY IN CHILDREN: RESULTS OF A MULTI-INSTITUTIONAL RETROSPECTIVE ANALYSIS BY THE TURKISH PEDIATRIC UROLOGY SOCIETY.

Onur KAYGISIZ 1, Tarkan SOYGUR 2, Mehmet Mesut PIŞKIN 3, Hasan Serkan DOĞAN 4, Yıloren TANIDIR 5, Serhat GÜROCAK 6, Bülent ÖNAL 7, Murat Can KIREMIT 8, Hakan KILIÇARSLAN 1, Berk BURGU 2, Yunus Emre GÖGER 3, Cem AKBAL 9, Eda TOKAT 6, Elif ALTINAY KIRLI 7, Yakup KORDAN 8 and Serdar TEKGÜL 4
1) Bursa Uludag University, Faculty of Medicine, Urology, Bursa, TURKEY - 2) Ankara University, Faculty of Medicine, Urology, Ankara, TURKEY - 3) Konya Necmettin Erbakan University, Meram Faculty of Medicine, Urology, Konya, TURKEY - 4) Hacettepe University, Faculty of Medicine, Urology, Ankara, TURKEY - 5) Marmara University, Faculty of Medicine, Urology, İstanbul, TURKEY - 6) Gazi University, Faculty of Medicine, Urology, Ankara, TURKEY - 7) Cerrahpasa University, Faculty of Medicine, Urology, İstanbul, TURKEY - 8) Koç University, Faculty of Medicine, Urology, İstanbul, TURKEY - 9) Marmara University, Faculty of Medicine,, Urology, İstanbul, TURKEY

PURPOSE

Pediatric retrograde intrarenal surgery (RIRS) has been increasingly applied to the upper urinary system stones in recent years. However, the number of studies on the pediatric RIRS is very limited. The aim of the study was to assess the predictive factors of the stone free (SF) status after pediatric RIRS.

MATERIAL AND METHODS

We retrospectively evaluated 369 renal units in 354 children treated with RIRS at eight referral centers. Stones were divided into three groups according to their size. (GroupI: <10mm; II: 10-20mm; III: >20mm) Renal stone index was calculated by dividing the length of the stone along its longest axis by the length of the kidney along its longest axis. Univariate and multivariate analyses were done to determine predictive factors affecting SF status.

RESULTS

Mean age was 7,1± 4,9 (0,5-17) years. Mean stone size was 11,77± 6,9 (3-43) mm. SF rate after one session of RIRS was 71.4%. When stone-free renal units were compared with other renal units, there were significant differences in the stone location, stone size, and renal stone index ( p<0.001, p<0.001, p=0.015; respectively). In multivariate analysis, factors that predicted failure were the stone size, stone location and power of holmium:yttrium-aluminium-garnet (Ho:YAG) laser lithotripsy machine. The risks of failure after RIRS were found 2,9 times higher for multiple locations (comparing to solitary location, p=0,014); 4,7 times higher for stones> 2 cm (comparing to stones <1 cm; p=0,029); 2,64 times higher for the use of low-power Ho:YAG laser lithotripsy machine (15/20 to 30 W, p=0,049).

CONCLUSIONS

Stones larger than 2 cm and multiple locations are the risk factors for failure in pediatric RIRS. High power lasers should be used during pediatric RIRS.


16:32 - 16:35
S23-6 (PP)

ABILITY OF ESWL NOMOGRAMS TO PREDICT STONE-FREE RATE IN CHILDREN

Erman CEYHAN 1, Cevahir OZER 2, Bulent OZTURK 1, Mehmet Llteris TEKIN 3 and Yuksel Cem AYGUN 3
1) Baskent University Konya Hospital, Department of Urology, Konya, TURKEY - 2) Baskent University Adana Hospital, Department of Urology, Adana, TURKEY - 3) Baskent University Ankara Hospital, Department of Urology, Ankara, TURKEY

PURPOSE

We aimed to evaluate the impact of pediatric extracorporeal shock wave lithotripsy (ESWL) nomograms for the prediction of stone-free rates in children with stone disease.

MATERIAL AND METHODS

We evaluated 372 children(<18 years) with eligible data who received ESWL treatment for stone disease in our clinics. Children’s age, gender, stone size, stone burden, stone location and history of previous intervention were recorded. Children without any residual fragments after ESWL treatment designated as stone-free. The nomograms formed by Dogan (Dogan et al. J Pediatr Urol. 2015 Apr;11(2):84.e1-6) and Onal (Onal et al. BJU Int. 2013 Feb;111(2):344-52) were implemented to our series for the prediction of stone-free state.

RESULTS

Mean age of children was 63.6±57.5 months. Male to female ratio was 200/172. 79.3%(295) of children had single stone. Mean stone size was 9.9±3.8mm. Our stone-free rate for single ESWL session was 55.6%(207/372). There were no significant difference between stone-free children and children with residual fragments regarding gender, age, history of previous intervention and stone burden. Stone-free rates showed significant relation with respect to stone size and stone location that median stone size in stone-free children were lower and lower pole stones had the lowest stone-free rate(p<0.05). The Receiver Operating Characteristic analysis of Dogan and Onal nomagrams revealed poor accuracy in our series that area under curve was 0.621 for Dogan nomogram and 0.576 for Onal nomogram.

CONCLUSIONS

Dogan and Onal nomograms demonstrate poor accuracy in prediction of stone-free status after pediatric ESWL treatment. New nomograms with proper scoring system should be generated.


16:35 - 16:38
S23-7 (PP)

FOLLOW-UP OF PEDIATRIC PATIENTS AFTER ENDOUROLOGICAL PROCEDURES FOR UPPER URINARY TRACT CALCULI

Yu ZHANG 1, Jun LI 2 and Ye TIAN 2
1) Beijing Friendship Hospital, Capital Medical University, Department of Urology, Beijing, CHINA - 2) Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China, Department of Urology, Beijing, CHINA

PURPOSE

To evaluate the recurrence of pediatric patients with upper urinary tract calculi after endourological surgery

MATERIAL AND METHODS

A prospectively managed database containing 348 children who were diagnosed with upper urinary tract calculi and treated with endourological surgery was analyzed from June 2014 to April 2019. We defined the stone recurrence as a new stone on imaging. We performed follow-up to assess the stone recurrence-free survival and Kaplan-Meier curves were used. Cox regression analysis was applied to determine the predictive factors.

RESULTS

Between June 2014 to April 2019, 348 children received endourological surgeries in our center. 31(8.9%) children had stone recurrence after a median follow-up of 27 months and the median stone recurrence-free survival was 30 months. The stone recurrence-free 1-yr, 2-yr, 3-yr, 4-yr probability was 96.4%, 90.3%, 89.0% and 87.8%, respectively. In multivariate analysis, significant hazard ratios for stone recurrence were as follows: 1.64 (95% CI 1.18-2.28) for 3-14 yrs children compared to infants younger than 1 yrs, 0.49 (95% CI 0.38-0.63) for underweight children compared to obese or overweight children, and 2.42 (95% CI 1.06-5.50) for children with stone mass above 2000 compared to children with stone mass below 1000.

CONCLUSIONS

The risk of kidney stone recurrence is high during childhood. Underweight patients or patients with massive stones preserved the higher recurrence rate. Etiological research of pediatric stones is urgently needed and prevention of pediatric urolithiasis is of greater importance than treatment.


16:38 - 16:47
Discussion