ESPU Meeting on Saturday 22, April 2023, 10:25 - 11:05
10:25 - 10:28
S24-1 (OP)
Eric BORTNICK, Michael KURTZ, Bartley CILENTO and Caleb NELSON
Boston Children's Hospital, Urology, Boston, USA
PURPOSE
Ureteroscopy is a common treatment for urolithiasis, but initial ureteral access is not always possible, particularly in pediatrics. Clinical experience suggests that neuromuscular conditions such as Cerebral Palsy (CP) may facilitate access, thus avoiding the need for pre-stenting and staged procedures. We sought to determine if incidence of successful ureteral access (SUA) during initial attempted ureteroscopy (IAU) is higher in pediatric patients with CP vs. without CP.
MATERIAL AND METHODS
We reviewed IAU cases for urolithiasis (2006-2021) at our center. Patients with pre-stenting, prior ureteroscopy, or surgical history were excluded. CP was defined using ICD-10 codes. SUA was defined as scope access to urinary tract level sufficient to reach stone. Association of CP and other factors with SUA were evaluated.
RESULTS
242 patients (45% male, median age: 16 years [IQR: 12-18y], 9.5% had CP) underwent IAU, with SUA in 193 (79.8%). SUA occurred in 91.3% of patients with CP vs. 78.5% of those without CP (p=0.18). SUA tended to be higher in patients >12 years (81.9% vs. 73.9%), and the highest SUA was in those >12years with CP (94.4%), but these differences were not statistically significant. Stone location was significantly associated with SUA (p=0.004). Among those with a renal stone only, SUA was higher in those with CP vs. those without CP (87.5% vs. 67.9%, p=0.14). Gender and BMI were also not statistically associated with SUA.
CONCLUSIONS
SUA during IAU tends to be higher for children with CP, although the difference was not statistically significant. Analysis of larger cohorts may show if CP truly facilitates access. Improved understanding of factors associated with initial access would help preoperative counseling and surgical planning for children with urolithiasis.
10:28 - 10:31
S24-2 (OP)
Yossi VENTURA and Roi MORAG
Schneider children's medical center, Urology, Petah Tikva, ISRAEL
PURPOSE
The prevalence of pediatric stone disease has increased over the last few decades. In children, the clinical attributes are not typical and require a high index of suspicion for correct diagnosis. We aimed to evaluate the role of microscopic hematuria as a diagnostic tool in children presenting with symptomatic urinary stones compared to the adult population.
MATERIAL AND METHODS
A retrospective review of consecutive cases of suspected symptomatic urinary stones between 2016-2021 at a pediatric referral center's emergency department. Collected data included: medical history, clinical symptoms, laboratory, and radiological findings. We compared the prevalence of microscopic hematuria in children with radiologically confirmed urinary stones to a similar adult cohort and examined the associations between microscopic hematuria and the clinical, laboratory, and radiological findings in children.
RESULTS
Of 184 patients reviewed, ninety-four children were diagnosed with symptomatic urinary stones confirmed by ultrasound (55%) or computed tomography (45%). Median age was 10 years (IQR 6-15) and 55% were males. Compared to an adult cohort [n=90, median age 52 years (IQR 41-65)], microscopic hematuria prevalence was significantly lower in children (62.8 vs. 82%, p=0.005). Reported clinical symptoms included flank/abdominal pain (47%), hematuria (27.7%), fever (21.3), and LUTS (12.8%). Children who presented with flank/abdominal pain and concurrent fever were associated with lower rates of microscopic hematuria on multivariate analysis [OR=0.24 (CI 0.06-0.089), p=0.03].
CONCLUSIONS
Microscopic hematuria prevalence is significantly lower in the pediatric population compared to the adult population and should not be used as a single guide to further evaluation when urinary stones are suspected.
10:31 - 10:34
S24-3 (OP)
Ahmed ABDELAZIZ 1, Mohamed EDWAN 1, Ahmed EL-ASSMY 1, Mohamed ABOUELGHAR 2 and Hassan ABOL-ENEIN 1
1) Mansour Urology Nephrology center, Urology, Mansoura, EGYPT - 2) Mansour Urology Nephrology center, Uro-radiology, Mansoura, EGYPT
PURPOSE
The first two years of life are critical for renal growth and functional maturation. We hypothesize that nephrolithiasis and its treatment during this formative period adversely affects long-term renal growth.
MATERIAL AND METHODS
A tertiary institution database was queried for children <18 years treated for kidney stones. Patients who were observed or treated medically and those with metabolic, anatomic or functional urinary tract abnormalities predisposing for nephrolithiasis were excluded. Renal growth was assessed based on ultrasound measurements of renal length plotted against percentiles for age. Impaired renal growth was defined as follow-up renal length <10th percentile for age with a normal baseline length (10th-90th percentile). Outcome was analyzed according to the age at first stone intervention (group A: age at first intervention ≤2 years, group B: age at first intervention >2 years).
RESULTS
A total of 120 renal units (33 in group A and 87 in group B) in 108 children were included in the analysis. Median age at the first stone intervention was 4 (1-14) years. Stone size, location, complexity, type and number of interventions, perioperative complications, stone recurrence and follow-up duration were not significantly different between both groups. After a mean follow-up of 61.8+23.1 months, 6/33 (18.2%) of group A and 26/87(29.9%) of group B had impaired growth (p=0.195).
CONCLUSIONS
Contrary to our assumption, intervention for kidney stones during infancy is not associated with impaired renal growth, compared to older children.
10:45 - 10:48
S24-4 (OP)
Levon ARUSTAMOV, Yuriy RUDIN, Arthur VARDAK, Daria GALITSKAYA, Diomid MARUKHNENKO, Georgiy LAGUTIN and Jamalutdin ALIEV
N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology - branch of the National Medical Research Centre of Radiology of Ministry of health of Russian Federation, Department of Pediatric Urology and Andrology, Moscow, RUSSIAN FEDERATION
PURPOSE
Indications for ESWL, URS and PNL in children are similar to adults (<1cm, 1-2cm, >2cm). The kidney size in children different ages (CDA) are not taken into account. The aim of the study: to define the large, medium and small kidney stone in CDA.
MATERIAL AND METHODS
we retrospectively analyzed 320 PNL (2008 - 2019): the average age - 6.6 y/o (1-17); the average stone size - 26 mm (15-58 mm) the average kidney length – 77 mm (62-112mm). Number of patients in different age groups: toddlers 1-3 y/o – 73 , pre-school child 3-5 y/o.- 71, school child 6-12 y/o – 79, adolescents 12-18 y/o – 107. The average weight - 21 kg (8–94 kg), the average height - 120 cm (73 – 180 cm)
RESULTS
Using mathematical modeling, we have created an estimation formula "Kidney stone size in children different ages" (KSS-CDA): KSS-CDA=(stone size (mm)/kidney length(mm))*100%. Definition of "large" kidney stone is used if KSS-CDA > 20%, “medium” 10-20%, “small” <10% Table1.
Table 1 - How one kidney stone size is interpreted differently in CDA
|
Age y/o |
1 |
5 |
17 |
|
Kidney length mm |
63 |
82 |
110 |
|
Kidney stone size mm |
13 |
13 |
13 |
|
KSS-CDA% |
20,63 |
15,8 |
11,8 |
|
Definition |
Large |
medium |
medium - small |
CONCLUSIONS
For the first time, we defined the criteria for large, medium, small kidney stones in CDA. In the future, KSS-CDA could be used to adapt clinical guidelines for treatment and nomograms for evaluating the treatment of urolithiasis in CDA.
10:48 - 10:51
S24-5 (OP)
Yesica QUIROZ MADARRIAGA, Alejandra BRAVO, Sofia FONTANET, Mireia FARGAS, Erika LLORENS and Anna BUJONS
Fundació Puigvert, Paediatric Urology, Barcelona, SPAIN
PURPOSE
Although stone disease in children is uncommon, urolithiasis in children with the exstrophy-epispadias complex (EEC) is not and it creates significant morbidity in the upper urinary tract (UUT). Patients with EEC have anatomically and functionally abnormal lower urinary tracts (LUT) that increase the risk of stones developing even before reconstruction. Our objective is to determine which factors may contribute to the recurrence of urolithiasis in these complex patients.
MATERIAL AND METHODS
A prospectively maintained database of 150 patients with EEC was reviewed. 34 patients were selected whom underwent treatment of urolithiasis with 119 procedures (73 in LUT and 46 in UUT) . Demographic data, type of urinary reconstruction, location and size of urolithiasis, symptoms, surgical approach, stone-free rate (SFR) latency time to recurrence and recurrence rate were collected. Multivariate analysis was performed and Kaplan-Meier curves were performed.
RESULTS
52,9% were men, 79,4% had bladder EEC. The majority had bladder augmentation (38,3%), followed by colonic conduits. 76% of procedures were in the kidney and 24% in ureter, with a SFR of 56% and 73%, respectively. The surgical approach in LUT was: 23,3% transurethral, 24,2% trans-Mitrofanoff, 27,4% percutaneous and 10% open, with a SFR of 97,2%. In 44.7% and 68,5% of the UUT and LUT procedures respectively, there were recurrences, with a median of 44 months and 18 months (Kaplan-Meier curves). In the multivariate analysis only obesity (OR 1.5) was statistically significant for recurrence in UUT and male gender (OR 41.8), bladder augmentation (OR 31.3) and urease positive bacteria in the urinary culture (OR 119.4) are risk factors for recurrences in the LUT.
CONCLUSIONS
Urolithiasis in the LUT of EEC patients is more frequent and recurrent (18m vs 44m) than in the UUT, with male gender, bladder augmentation, and urease-positive bacteria being statistically significant risk factors for recurrence.
10:51 - 10:54
S24-6 (OP)
Ezel AYDOĞ, Mehmet Fatih ÖZKAYA, Furkan ÖZSOY, Elif İpek AKSOY, Tarkan SOYGÜR and Berk BURGU
Ankara University School of Medicine, Urology, Ankara, TURKEY
PURPOSE
There are not many researches regarding the management modality for pediatric patients, especially infants. Because of the lack of prospective randomized researches, while ESWL has a more impactful role, the overall management for pediatric patients is almost the same with adults. We aimed to study different management options for infants with the urinary stone disease.
MATERIAL AND METHODS
136 patients that were consulted to our clinic between Jan-2018 to Apr-2022 with incidentally detected 5-10 mm renal stones were randomized into two groups for this prospective study. The treatment group, had undergone a metabolic evaluation and a low-dose CT if required apart from the Ultrasound scans. ESWL was the preferred first approach unless the stone location was lower pole or patient had a history of a prior failed ESWL. Afterwards, either URS or PCNL were preferred depending on the ureter calibration. The control group did not undergo any further diagnostic tesst or surgical approach, unless a G2 hydronephrosis or febrile UTI presented. Two sample t-test was used for statistical analysis.
RESULTS
All patients were followed every 2 months during infancy period. 23% of patients (n = 16) in the control group were eventually treated with ESWL because of obstruction during ureteral stone passage. 50% of patients (n = 34) had spontaneous passage of stone without any complications. At the end of the infancy, there was no significant difference of change on kidney functions between two groups.
CONCLUSIONS
5-10mm kidney stones on infants that doesn't cause >G2 hydronephrosis or febrile UTIs can safely be followed without any intervention or extensive metabolic evaluation during the infancy period.