ESPU Meeting on Saturday 11, June 2022, 10:15 - 10:55
10:15 - 10:18
M S ANSARI 1, Priyank YADAV 2 and Prabhu N KARUNAKARAN 2
1) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Pediatric Urology, Department of Urology and renal transplantation, Lucknow, INDIA - 2) Sanjay Gandhi Post Graduate Institute of Medical Science, Div. Of pediatric Urology Department of Urology and Renal Transplantation, Lucknow, INDIA
To retrospectively evaluate the efficacy and safety of mini percutaneous nephrolithotomy (mPCNL) and retrograde intrarenal surgery (RIRS) in children with renal and pelvic calculus between 10 to 20 mm.
MATERIAL AND METHODS
Children with renal and pelvic caliculi less than 20 mm who underwent the mPCNL or RIRS from year January 2011 to January 2021 were analysed. Patients were divided into two groups: Group I (mPCNL), 20 patients; and Group II (RIRS), 20 patients. Patients were evaluated preoperatively with ultrasound KUB, low dose NCCT, and renal scans, postoperatively with USG KUB, after 1,3 ,12 months of procedure. The collected data were analysed.
The mean age in Group was 6.3 years and 8.7 in Group II. The mean stone size was 15.32 mm in Group I, and 13.00 mm in Group II. Group II, showed longer operating time 80.4 vs 55.7 min, but shorter postoperative hospital stays [4 vs 2.9 days) (p value 0.04). The overall stone-free rate (SFR) was 95.2% for Group I, and 80 for Group II after first attempt (p=0.001). The re-treatment rate was significantly higher in Group II compared to Group I [20.0% vs 0.0%] (p 0.03). The need of analgesia was less in Group II as compared to Group I. The complication rate was 10% and 20% for Groups I and II, respectively (p=0.055). The Clavien Dindo grade of complication (IIIb) was higher in the Group II as 2 (10%) patient developed hydrothorax secondary to supracostal approach needing intervention for its resolution.
Both the procedures are effective for the treatment of renal stone under 20 mm. RIRS remains a good alternative treatment choice with low complication rates, short hospital stay, less analgesic requirements but with slightly higher retreatment rate as compared to mini-PCNL.
10:18 - 10:21
Nicolas ROSIERE, Tatiana SZKLARZ, Luciana DIAZ ZABALA, Felicitas LOPEZ IMIZCOZ, Javier RUIZ, Santiago WELLER, Yesica GOMEZ, Carol BUREK, Cristian SAGER and Juan Pablo CORBETTA
Hospital Nacional de Pediatria Prof. Dr. Juan P. Garrahan, Urology, Ciudad Autonoma De Buenos Aires, ARGENTINA
Disposable ureterorenoscopes have gain popularity in adults but there is sparse data regarding their performance, and accessibility to the entire collecting system in pediatric patients. Our goal is to analyze outcomes in terms of stone free rate in retrograde intrarenal surgery (RIRS) performed with disposable ureterorenoscopes in children.
MATERIAL AND METHODS
Retrospective analysis of all RIRS performed with flexible disposable ureterorenoscopes LithoVue ™ 9,5 Fr (Boston Scientific, USA) from January 2018 to June 2021. Demographic characteristics, stone features (number of stones, volume, localization, Hounsfield Units (HU), infundibulopelvic angle (IPA) measurement), use of pre stenting or ureteral sheath and postoperative complications were collected. Stone free rate was defined as residual stones less than 4 mm.
In the analyzed period 38 RIRS were performed. Mean age at surgery was 10.34 years. Comorbidities presented in 20 patients, 45% were uropathies. Mean stone burden was 0.82 cm3, mean HU value was 881.91 and mean IPA was 76.6°. Multiple stone were present in 46% of the cases. Most frequent stone localization was inferior renal calyx. Previous stent with JJ catheter was performed in 61%. Ureteral access sheath was used in 42%. Four patients had postoperative complications, with no relation with previous use of JJ catheter or ureteral sheath. Stone free rate was 76%. Variables related to outcome are described in table 1.
RIRS using flexible disposables ureterorenoscopes presented acceptable SFR. Lower calyx localization, multiples stones and stone burden > 1 cm3 were endpoints associated with lower stone free rates.
10:24 - 10:27
Sadaf ABA UMER KODWAVWALA 1, Bashir AHMED 2 and Sajid SULTAN 2
1) Sindh Institute of Urology & Transplantation, Philip G. Ransley Department of Paediatric Urology, Karachi, PAKISTAN - 2) SINDH INSTITUTE OF UROLOGY AND TRANSPLANTATION, PHLIP G.RANSLEY DEPARTMENT OF PAEDIATRIC UROLOGY, Karachi, PAKISTAN
Different scoring systems are developed to predict the outcome of PCNL in adults and children. Children encompass varying age and weight. Aim of the study is to assess the effectiveness (in terms of predicting stone free status (SFR) and complications) of the two scoring system i.e.Guy's scoring system(GSS) and stone kidney scoring (SKS)in children upto10 kg.
MATERIAL AND METHODS
Retrospective analysis of the medical records of children upto 10kg,who underwent PCNL between June 2016 and 2021.GSS and SKS were calculated by filling the variables for each patient.Demography and outcome parameters were compared. Statistical analysis was done on SPSS v.20.0. p value <0.05 was considered significant.
188 children,238 renal units (RU) underwent PCNL.Median age was 2 year(6 months-7 years),median weight 8.8kg(4.6kg-10kg). M:F =2.1:1. Guy's score was calculated as I=74,II=130,III=25 and IV in 9RU.Stone Kidney Index (SKI)<0.3=115RU and >0.3=123 RU.SKS-2=77,3=47 and 4=114 RU. Overall SFR=210(88.2%) which increased to 92% after including residual fragment upto0.4cm. SFR in Guy's I=92%,II=88%, III=80% and IV=78% (p=0.3) whereas in SKS 2=93.5%,3=85.5% and 4 =86% (p=0.21).However, when SFR was assessed in SKI, it was 93.9% in <0.3 and 82.9% in >0.3 (p = 0.009). Mean operative time,Hemoglobin drop,Blood transfusion and hospital stay were also calculated among different system and were insignificant. Overall complications were 23.5%(CD grade 1-3). In Guy's I=18, II=27, III=8 and IV=3 (p= 0.56) whereas in SKS 2=26%, 3=17% and 4=24.6% (p= 0.48). SKI <0.3 had complication 26/115 and >0.3 = 30/123 (p= 0.76).
GSS and SKS are not very helpful in predicting the stone free status and complications of PCNL in small children upto 10 kg weight. SKI could help in predicting the stone free status.. In small children along with stone size and numbers other parameters including calyceal anatomy, stone density and location and surgical expertise also play an important role.
10:27 - 10:30
Giuseppe COLLURA, Michele INNOCENZI, Ermelinda MELE, Laura DEL PRETE, Ludy LOPES MENDES, Claudia FEDE SPECCHIALE and Marco CASTAGNETTI
Bambino Gesù Children Hospital and Research Center, Pediatric Urology Unit, Rome, ITALY
To compare miniaturized percutaneous nephrolithotomy performed with an aspiration system, VAmini-PCNL, vs. RIRS for the treatment of renal stones between 2 and 3 cm in diameter. Our hypothesis was that VAmini-PCNL allowed for a higher stone-free rate and lower need for secondary procedures.
MATERIAL AND METHODS
Retrospective study of 15 patients with renal stones [8 males; median (range) age 6.6 years (14 months-12 years), median stone size (range) 2.4 (2-2.8) cm] undergoing VAmini-PCNL (16Ch ClearPetra sheath, 12 Ch endoscope and laser lithotripsy) between 11/2018 and 09/2020. These patients were compared with 15 patients matched for gender, age, and stone size [8 males, median (range) age 7.7 years (18 months-14 years), median stone size (range) 2.3 (2-2.7) cm] undergoing standard RIRS for renal stones in the same period. End points included need for pre-stenting, operative times, intraoperative complications, and stone-free rate at 1 month follow-up (no fragments >5 mm on ultrasound), and need for secondary surgery.
Five patients were pre-stented, all before RIRS (33% vs. 0, p=0.04). Median (range) surgical time was 80 (60-115) minutes for VAmini-PCNL vs. 150 (110-200) minutes for RIRS (p=0.00001). The planned procedure was completed in all patients irrespective of age and no intraoperative complications occurred. At 1 month follow-up, all patients undergoing VAmini-PCNL were stone-free vs. 9/15 (60%) of those undergoing RIRS, p=0.02. The 6 (40%) non-stone-free RIRS patients had lower calyx fragments and underwent a second RIRS.
In our experience, both procedures could be performed without complications in patients between 1 and 14 years presenting with renal stones of 2- to 3-cm in diameter. VAmini-PCNL was associated with significantly shorter operating time and higher stone free-rate. RIRS required significantly more often pre-stenting and a second procedure for residual fragments.
10:30 - 10:33
Bartłomiej SOBOLEWSKI and Adam HALINSKI
Private Medical Center "Klinika Wisniowa", Deparment of Peadiatric Urology, Zielona Gora, POLAND
Urolithiasis in children is a globally growing problem. Annual reports show the increase in the number of hospitalizations. Kidney stone disease in the pediatric population is a multifactorial disease. Due to a high risk of recurrence, the children require surgical intervention and anesthesia practically every time. There are studies confirming the negative effect of general anesthesia. The aim of this paper is to introduce the method, safety and effectiveness of treating urolithiasis in children with the application of ESWL using regional anesthesia QLB and limiting the use of intravenous anesthetics and analgesics during and after the procedure.
MATERIAL AND METHODS
All the presented procedures were performed in a one-day urology mode. In a prospective study, we evaluated 211 patients (aged 2-18 years;mean 8.7) treated for urolithiasis with the stone size 5-20 mm (mean 10.7 mm) according to the VAS scale: during the puncture and in the 5th, 10th, 15th, 20th and 25th minute of the procedure, after the procedure, at discharge, and during the morning follow-up.
The length of the treatment varied from 25 to 45 minutes. The length of hospital stay from 5 to 7 hours (mean 5.5 hours). In all the cases the VAS scale did not exceed 4 points. Only three of the children required urgent admission to the hospital at night. The follow-up ultrasound evaluation was performed at the clinic the next morning. The overall efficiency of the ESWL procedure was 83.5%. After the follow-up ultrasound examination only 5% of the patients required admission to the hospital for an endoscopy procedure. The duration of pain relief was observed from 8 to 36 hours (a mean 14 hours) after the QLB analgesia.
The number of patients and results of clinical analysis confirmed, that such an anesthesia strategy in ESWL procedure is secure and effective, and has numerous advantages.