ESPU Meeting on Friday 10, June 2022, 16:30 - 17:05
16:30 - 16:33
S16-1 (OP)
Rocio LIZARRAGA RODRIGUEZ, Leire LARREINA DE LA FUENTE, Nerea GONZALEZ TEMPRANO, Flor De Nieve VILLALON FERRERO, Marina ROMAN MOLEON and Alexander URBISTONDO GALARRAGA
Hospital Universitario Donostia, Cirugia Pediatrica, San Sebastian, SPAIN
PURPOSE
Pediatric ureteral stent removal regarding urological procedures require another cystoscopy under general anesthesia (GA), which is considered to be its main disadvantage in children. Magnetic stent retrieval system is a simpler and less invasive alternative. We aim to report our initial experience with these stents among pediatric population.
MATERIAL AND METHODS
We performed a prospective cohort study, from 2018-2021, involving pediatric (<14 years) patients. The studied variables were as follow: initial diagnosis, surgical procedure, stent insertion success rate, complications, failure of non-surgical removal requiring GA and mean pain score during removal.
RESULTS
A total of 21 patients and 23 placed magnetic stents (4.8Fr, 15cm-20cm) were included. Mean age was 5.01 years, with 62% of male predominance. Surgical indication for stent placement summarizes in: 34.8% following open pyeloplasty, following pyeloureteral (21.8%) and ureterovesical junction (17.4%) endoscopic balloon dilatation. Ureteroscopy laser lithotripsy stent placement accounts for 13,1% of cases, while renal trauma, pyonephrosis cystoscopic drainage and retroiliac ureter account for 4.3% each. The median duration of stent indwelling was 4.2 weeks. There were three stent related complications (13%): urinary tract infection, stent obstruction and stent migration. 95,7% of the stents were succesfully retrieved on an outpatient basis without GA. Mean pain score was recorded as none or very mild.
CONCLUSIONS
Magnetic double J stent represent a safe and effective alternative to traditional stents, avoiding the need for general anesthesia, reducing OR time and decreasing overall costs.
16:33 - 16:36
S16-2 (OP)
Sebastien FARAJ, Thomas LOUBERSAC, Aurelien GRAVELEAU, Hortense ALLIOT, Caroline CAMBY and Marc-David LECLAIR
CHU Nantes, Pediatric surgery, Nantes, FRANCE
PURPOSE
A wide range of surgical interventions have been described for the management of primary obstructive megaureter (POM), varying from open reimplantation to minimally invasive procedures such as ureter stenting or endoscopic balloon dilatation.
We aimed to assess the need for placement of a double J stent after endoscopic balloon dilatation procedure, by comparing the post-operative related outcomes with and without double J placement. Secondary outcome was the need for further procedure after endoscopic balloon dilatation in the two groups.
PATIENTS AND METHODS
Historical retrospective comparison of children treated by endoscopic dilatation for POM, with post-operative JJ stent left in place (2012-2014) or without ureteral JJ stent (since 2015). Outcomes were reported following Clavien-Dindo grading system and compared between the two groups. Success rate was defined as absence of need for further surgical reimplantation.
RESULTS
Endoscopic dilatation was performed in 42 patients for 46 renal units during the study period. There was a significantly higher rate of post-operative complications in the group with JJ stenting compared to the group without double J stenting regarding all Clavien-Dindo grades (56% vs 31%, p=0,014) and Clavien-Dindo grade III only (5/16 vs 0/26, p=0,0051). The success rate was similar in the JJ group (75%, F-up: 70 months [13-101]) and the no JJ group (81%, F-up: 26 months [12-95]).
The success rate was comparable to previous studies reviewing endoscopic dilatations. The overall rate of complications was slightly higher than in other reports, mostly related to the presence of JJ stent.
CONCLUSIONS
Most post-operative complications after endoscopic dilatation of POM are related to the presence of a JJ stent. In our study, the omission of postoperative ureteral drainage by a JJ stent seems to have no demonstrable impact on the success rate of endoscopic dilatation of POM.
16:36 - 16:39
S16-3 (OP)
Ahmed FAHMY, Mohamed YOUSSIF, Haytham BADAWY, Walid DAWOOD, Amr KAMAL and Assem GHOZLAN
Alexandria Faculty of Medicine, Urology Department, Alexandria, EGYPT
PURPOSE
Percutaneous punctures directed at the papilla of the renal calyx during percutaneous nephrolithotomy (PCNL) is the standard practice by most endourologist. More recently, non papillary, mid-calyceal infundibular punctures was popularized in adults and reported to have comparable safety and without greater risk of bleeding complications compared to papillary puncture. A prospective randomized study was performed to look at the efficacy and safety of the non papillary approach during pediatric mini-PCNL.
MATERIAL AND METHODS
Children with renal stones with an accumulative size of at least 2 cm were randomly assigned to one of two parallel groups to undergo mini-PCNL with either papillary (Group 1) or non papillary (Group 2) renal access.
The primary outcome measures were the intraopertive blood loss and the subsequent need for transfusion. Secondary endpoints included the operative and fluoroscopy time, stone free rate, hospitalization time and overall complication rate during the first postoperative month.
RESULTS
In total, 60 children were equally divided into Groups 1 and 2. Age ranged from 6-18years Patients' demographics and stone characteristics were similar among the two groups.
The stone free rate, overall complications rate and postopertaive hospital stay were comparable between both groups.
Group 1 had a significantly higher rate of intraoperative blood loss and and transfusion rate (p = 0.012, p = 0.04, respectively). Operative time was significantly longer in Group 1 (p = 0.036).
CONCLUSIONS
The non papillary approach had comparable efficacy to the papillary approach. However, it was associated with significantly higher rate of blood loss with subsequent need for transfusion and longer operative time. Non papillary approach has not shown comparable safety to the standard papillary approach for mini-PCNL in children.
16:39 - 16:42
S16-4 (OP)
Ahmed FAHMY, Mohamed YOUSSIF, Haytham BADAWY, Walid DAWOOD, Amr KAMAL and Assem GHOZLAN
Alexandria Faculty of Medicine, Urology Department, Alexandria, EGYPT
PURPOSE
Single step dilation technique has been reported to be safe and effective. In this study, we aimed to compare the safety, efficacy and perioperative complications of single step versus serial tract dilation, using Alken metal telescopic dilators during pediatric PCNL.
MATERIAL AND METHODS
Between April 2017 and May 2020, all children who were candidates for PCNL were enrolled in this prospective randomized study. Patients were randomized between the two treatment groups according to the dilation technique used. In group A. Alken telescopic metal dilation was employed, and in group B, single step dilation technique was performed.
The primary outcomes were access time and complications rate.The assessor conducting analyses of the outcomes was blinded to the treatment groups.
RESULTS
A total of 75 patients were randomized to group A (38 patients) and group B (37 patients).There were no differences in demographic characteristics, operative duration, total fluoroscopy time, stone free rate and postoperative hospital stay between the two groups.
Access was successfully obtained in all procedures.Access time and dilation fluoroscopy time was statistically significantly shorter in group B compared to group A (p =0.034 and 0.042, respectively).
Patients in group A had a significantly higher rates of complications compared to patients in group B (28.5 % versus 14.2%). Intraoperative bleeding requiring blood transfusion was statistically higher in group A compared to group B (11.4% versus 2.8 %, P= 0.045). There were no major complications (modified Clavien IV or higher) in the study population.
CONCLUSIONS
Compared with serial metal track dilation, single step dilation technique showed comparable operative duration and stone free rate during pediatric PCNL, with significantly reduced access time and dilation fluoroscopy time. Intraoperative bleeding requiring blood transfusion was significantly lower in single step dilation group.
16:42 - 16:45
S16-5 (OP)
Shrjeel SAULAT, Hamza ASHRAF, Ashba MUSHTAQUE and Syed Saeed Uddin QADRI
Tabba Kidney Institute, Pediatric Urology, Karachi, PAKISTAN
PURPOSE
To evaluate the safety of different Amplatz sheath sizes used in pediatric Percutaneous Nephrolithotomy in terms of post operative outcomes of hemoglobin drop and stone clearance.
MATERIAL AND METHODS
500 patients underwent Percutaneous Nephrolithotomy within 5 years (from 2017 till 2021); the patients were categorized into two groups according to size of Amplatz sheath used for procedure. Group A consist of 240 (48%) patients with 12-18 Fr Amplatz sheath, while Group B had 260 (52%) patients with 20-22 Fr Amplatz sheath. Comparison of pre and post operative hemoglobin drop, need for blood transfusion , stone clearance rate and mean operative time for stone clearance was assessed. To assess the importance of data chi-square test was used, p value <0.05 was considered significant.
RESULTS
Median age and interquartile range of Group-A and Group-B patients was (12; 7) and (13; 5) years respectively. While stone size of Group-A and Group-B patients reported as (2.0; 0.60) and (2.1; 0.70) cm. The operative time and interquartile ratio of Group-A and Group-B patients was (75; 45) and (85; 45) minutes and we found significant change in HB of Group-A (0.90; 0.80) with Group-B patients (1.90; 0.70) gm/dl respectively [p = 0.000].transfusion in Group A (12-18 Fr). Group B required noticeably less operative time with no added benefit.
CONCLUSIONS
This concludes that smaller size of Amplatz sheath (12-18 Fr) in Percutaneous Nephrolithotomy can be used in pediatric population with safety and better outcomes in terms of postoperative blood loss, post-operative transfusion rate and stone clearance.