ESPU Meeting on Saturday 22, April 2023, 11:05 - 11:45
11:05 - 11:08
S25-1 (OP)
Alice FAURE 1, Annabel PAYE JAOUEN 2, Delphine DEMEDE 3, Melodie JURICIC 4, Alexis ARNAUD 4, Camille GARCIA 5, Olivier ABBO 5, Nathalie BOTTO 6, Thomas BLANC 7, Marc-David LECLAIR 8 and Thomas LOUBERSAC 8
1) Hôpital de la Timone enfant, Paediatric surgery, Marseille, FRANCE - 2) APHP - Robert Debré, Pediatric surgery, Paris, FRANCE - 3) Hospices Civils de Lyon Groupement Hospitaliser Est, Pediatric surgery, Bron, FRANCE - 4) CENTRE HOSPITALIER UNIVERSITAIRE DE RENNES, Pediatric surgery, Rennes, FRANCE - 5) CHU Toulouse, Pediatric surgery, Toulouse, FRANCE - 6) APHP -Necker Enfants Malades, Pediatric Surgery, Paris, FRANCE - 7) APHP Necker Enfants Malades, Paris, FRANCE - 8) CHU Nantes, Pediatric surgery, Nantes, FRANCE
PURPOSE
To assess safety and efficacy of ureteroscopy (URS) for the treatment of urinary stones in children under 5 years.
MATERIAL AND METHODS
After the institutional ethical board approval was obtained, we conducted a retrospective, analytic, multicentric study that included all URS performed between January 2016 and April 2022 in children
RESULTS
83 patients, median age 3.6 years(0.8-5), underwent 96 URS. Median patient weight and stone size were 14 Kg(6.3-23) and 13 mm(4-45), respectively. Pre-stenting was performed in 52 (54%) of patients. The global SFR was 67.5%. Median hospital stay: 2 days(1-6).
There were 65 (67%) renal stones, treated with flexible URS. A ureteral access sheath and Holmium laser lithotripsy were used in 91% and 96% procedures, respectively. SFR after the first procedure of flexible URS was 56 %. There were 16% (11/66) Clavien-Dindo (CD) I-II complications and 9% (6/66) cases of CD IIIb.
Single stage SFR was achieved in 89% for the 31 (32%) ureteric stones with minor complications (3.3% of CD I-II).
CONCLUSIONS
URS in patients
11:08 - 11:11
S25-2 (OP)
Yesica QUIROZ MADARRIAGA 1, Daniel CASTELLANI 2, Yiloren TANIDIR 3, Cagri Akin SEKERCI 4, Ee Jean LIM 5, Khi Yung FONG 6, Bhaskar SOMANI 7, Olivier TRAXER 8, Vineet GAUHAR 9 and Anna BUJONS 1
1) Fundacio Puigvert, Paediatric Urology, Barcelona, SPAIN - 2) Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Urology, Ancona, ITALY - 3) Marmara University School Medicine, Urology, Istambul, TURKEY - 4) Marmara University School of Medicine, Urology, Istambul, SPAIN - 5) Singapore General Hospital, Urology, Singapore, SINGAPORE - 6) National University of Singapore, Yong Loo Lin School of Medicine, Urology, Singapore, SINGAPORE - 7) University Hospital Southampton NHS Foundation Trust, Urology, Southampton, UNITED KINGDOM - 8) Hospital Tenon, Urology, Paris, FRANCE - 9) Ng Teng Fong General Hospital, NUHS., Urology, Singapore, SINGAPORE
PURPOSE
Retrograde intrarenal surgery (RIRS) is an option for pediatric kidney stone upto 1cm in EAU guidelines and many urologist do RIRS for > 1 cm stones as well if they have sufficient experience. Our aim is to assess the outcomes of pre-stenting versus non-pre-stenting in a pediatric population undergoing RIRS for intrarenal stones in different age groups and locations .
MATERIAL AND METHODS
Data collected on Children/adolescents with kidney stones undergoing RIRS in 9 centers between 2015-2020 were retrospectively reviewed. Stone-free status was evaluated at 3-month and defined as a single residual fragment (RF) ≤2mm/absence of multiple fragments. Patients were divided into two groups (Group 1 no-pre-stenting). Student's, Chi-square and Fisher's exact test was used to assess difference between groups. Univariable and multivariable logistic regression analysis were performed to predict RF. Statistical significance: p-value <0.05.
RESULTS
389 children/adolescents were included (192 patients in Group 1). Pre-stented patients were younger compared with non-presented (mean age 8.30±4.93 vs 10.43±4.30 years, p<0.001). There were no differences in stone characteristics (number, size, locations). Lasing and total surgical time were similar. Urinary tract infections (Clavien grade 2) were more prevalent in Group 2 (10.7%) compared to Group 1 (3.7%, p=0.016). Sepsis (Clavien grade 4) occurred in 2.1% of patients in Group 2 and no patient in Group 1 (p=0.146). 30.7% patients in Group 1 and 26.4% in Group 2 had RF (p=0.322). Multivariate logistic regression analysis showed that stone size was associated with RF (OR 1.20 95% CI 1.08-1.36, p=0.001).
CONCLUSIONS
RIRS showed similar stone-free rate in pre and non-pre-stented children/adolescents, In this multicenter study, we found that preoperative positioning of ureteral stent had no effect in clearing stones but a higher incidence of postoperative infections. Whilst routine pre-stenting cannot be recomended it becomes imperative that the child's guardian is counseled appropriately about pros and cons of prestenting including need for additional anesthesia.
11:11 - 11:14
S25-3 (OP)
Yesica QUIROZ MADARRIAGA 1, Esther GARCIA 2, Diana VALLEJO 3, Daniele CASTELLANI 4, Yiloren TANIDIR 5, Deepak RAGOORI 6, V Chandra MOHAN 7, Ee Jean LIM 8, Khi Yung FONG 9, Bhaskar SOMANI 10, Olivier TRAXER 11, Vineet GAUHAR 12 and Anna BUJONS 1
1) Fundacio Puigvert, Paediatric Urology, Barcelona, SPAIN - 2) HM Sanchinarro, Urology, Madrid, SPAIN - 3) University of Cartagena, Urology, Cartagena, COLOMBIA - 4) Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Urology, Ancona, ITALY - 5) Marmara University School of Medicine, Urology, Istambul, TURKEY - 6) Asian Institute of Nephrology & Urology, Urology, Telangana, INDIA - 7) Preeti Urology and Kidney Hospital, Urology, Telangana, INDIA - 8) Singapore General Hospital, Urology, Singapore, SINGAPORE - 9) National University of Singapore, Yong Loo Lin School of Medicine, Urology, Singapore, SINGAPORE - 10) University Hospital Southampton NHS Foundation Trust, Urology, Southampton, UNITED KINGDOM - 11) Hospital Tenon, Urology, Paris, FRANCE - 12) Ng Teng Fong General Hospital, NUHS., Urology, Singapore, SINGAPORE
PURPOSE
To compare the outcomes of using low power (up to 30 W) versus high power (up to 120 W) holmium lasers in pediatric retrograde intrarenal surgery (RIRS) and to analyze whether the choice of scopes, laser settings and the use of ureteral access sheath have any influence on the final outcomes
MATERIAL AND METHODS
We performed a retrospective, multicentric study in a paediatric population (≤ 18 years of age), who underwent RIRS with holmium laser for treatment of kidney stones between January 2015 and December 2020. Patients were divided into two groups according to the laser used: high-power holmium laser (HP.Ho-Yag) and low-power holmium laser (LP.Ho-Yag). Clinical, perioperative variables and complications were analyzed. Statistical analysis with Student's T-test, Chi-square, Fisher's exact test and multivariate analysis was performed.
RESULTS
314 patients from 9 centres were included. HP.Ho-Yag was used in 97 patients, whereas 217 patients underwent a LP.Ho-Yag. Within the preoperative and demographic characteristics only the use of previous JJ (41% in LP vs 21.8% in HP, p 0.004), positive urine culture (23.3% LP vs 7.2% HP) and stone size (9.7mm LP vs 11.1mm HP, p 0.018) were statistically different. No differences were found in the use of ureteral sleeve or fragmentation time, but there were differences in the use of thicker equipment, greater use of postoperative JJ and longer operative time in the LP.Ho-Yag group, with significantly higher SFR (mean 81.4% Hp-Ho-Yag vs 59% LP-Ho-Yag; p <0.001). We found no statistical differences in complication rates. In the multivariate analysis, the factors that decrease SFR were the use of LP.Ho-Yag, the diameter of the stone and the multiplicity of the stones.
CONCLUSIONS
Our real-world pediatric multicenter study favours HP.Ho-Yag and establishes its safety and e�ficacy in children. With innovations, it would be best adapted to provide the best possible SFR results in a single session of RIRS.
11:25 - 11:28
S25-4 (OP)
Yesica QUIROZ MADARRIAGA 1, Isabel SANZ 1, Ragoori DEEPAK 2, V. Chandra MOHAN 3, Olivier TRAXER 4, Erika LLORENS 1, Vineet GAUHAR 5 and Anna BUJONS 1
1) Fundacio Puigvert, Urology, Barcelona, SPAIN - 2) Asian Institute of Nephrology & Urology, Urology, Telangana, INDIA - 3) Preeti Urology and Kidney Hospital, Urology, Telangana, INDIA - 4) Tenon Hospital, Urology, Paris, FRANCE - 5) Ng Teng Fong General Hospital, NUHS., Urology, Singapore, SINGAPORE
PURPOSE
In the last two decades endourology has been miniaturized and has improved technology to continue to be effective. One of the latest innovations has been the new SuperPulsed Thulium fiber laser (TFL), which allows a wider range of energy (from 0.025 to 6.0 J) and frequency (up to 2000 Hz). Our aim is to describe the initial clinical results of retrograde intrarenal surgery (RIRS) with TFL in children with upper urinary tract lithiasis.
MATERIAL AND METHODS
A prospective study was performed in children with lithiasis disease treated with RIRS from December 2020 to June 2022 in 6 centers in Europe and Asia. Demographic data, clinical data, stone size and location, laser settings, intraoperative variables, stone-free rate (SFR) and complications were collected. Student's t-test, Fisher's test and Mann Whitney U test, were performed.
RESULTS
40 patients were included. The mean age was 8.5 years, 67.5% boys. The mean size of the stone was 9.7mm, 50% were multiple. Ureteral access sheath (UAS) was used in 65% cases. TFL was used in all cases (100Hz and 0.2J). The fiber used in all cases was 150μm. Fragments were extracted in only 30% of the cases, for crystallographic study protocol. There were no intraoperative or postoperative complications. The SFR was 90%, being statistically significant its relation with height (p=0.017), number of stones (p=0.047), location (p=0.036) and use of UAS (p=0.043).
CONCLUSIONS
The Superpulsed TFL is an efficient and safe tool for RIRS in the pediatric population, showing good results in SFR, which is related to the height, number of stones, location and use of UAS. The use of a thinner fiber allows a greater deflection of the flexible ureteroscope, increasing the success in LC and the better quality of dusting reduces the need for the use of a basket.
11:28 - 11:31
S25-5 (OP)
Bashir AHMED, Sajid SULTAN and Sadaf ABA UMAR
Sindh Institute of Urology & transplantation, Philip G Ransley Department of Paediatric Urology, Karachi, PAKISTAN
PURPOSE
To compare the safety, efficacy, and outcome of M-PCNL in CKD Children’s stages.
MATERIAL AND METHODS
Records of 85 children (115 renal units) in single or multiple locations of renal stones managed by M-PCNL from January 2020 to December 2021 were reviewed. Patients were divided into three groups according to the KIDGO Classification of CKD. In Group I CKD Stage II Patients (n=42), Group II, Stage III (n=58), and Group III Stage IV (n=15). Clinical records were reviewed for age, gender, stone, laterally, location, size, stone clearance, Redo PCNL, and complications. ANOVA independent t-test and Chi-square test were used for statistical analysis.
RESULTS
|
Renal unit (M/F 1.8:1) N=115 |
||||
|
Mean age 6.3+/-3.0yrs |
Group A Mean age 6.1+/-3.4yrs N=42 |
Group B Mean age 6.2+/-2.8yrs N=58 |
Group C Mean age 7.1+/-2.9yrs N=15 |
P=Value |
|
Stone size (cm2) |
6.3+/-7.6 |
6.8+/-9.1 |
5.4+/-3.9 |
0.84 |
|
Pre-Op: Hb (gm%) 10.4+/-1.84 |
10.8+/-1.07 |
10.9+/-1.22 |
10.1+/-0.89 |
|
|
Per Op: Blood tx. |
14.3% |
17.2% |
0.00% |
0.22 |
|
Post-Op: Hb (gm%) 10.4+/-1.84 |
10.1+/-1.5 |
10.6+/-1.65 |
10.0+/-0.96 |
0.20 |
|
Post-Op: Blood tx. |
21.4% |
15.5% |
40% |
0.11 |
|
Pre-Op: S. Cr (mg%) 1.13+/-0.64 |
0.66+/-0.17 |
1.1+/-0.32 |
2.4+/-0.60 |
<0.001 |
|
Pre-Op: S. Cr (mg%) 1.10+/-0.67 |
0.72+/-0.28 |
1.2+/-0.40 |
2.4+/-0.68 |
<0.001 |
|
Per-Op: Complication (Drain Placement ) |
7.1% |
6.9% |
26.7% |
0.05 |
|
Post-Op: Complication |
26.3% |
8.6% |
20.0% |
0.06 |
|
Stone-free rate Monotherapy |
73% |
74% |
66.7 |
0.83 |
|
Stone free rate after REDO PCNL/ESWL |
85.7% |
86.2% |
86.7% |
0.99 |
The stone size and stone-free rate are comparable between the groups. Overall complication clavian 1 22(20%), Clavian II 8(7%) and Clavian III, 13(11.3%).
CONCLUSIONS
The study showed that all three groups had good stone clearance with an acceptable complication rate. The stage of CKD did not effect stone clearance.
11:31 - 11:34
S25-6 (OP)
Yiloren TANIDIR 1, Yesica QUIROZ MADARRIAGA 2, Cagri Akin SEKERCI 3, Daniele CASTELLANI 4, Ee Jean LIM 5, Khi Yung FONG 6, Bhaskar Kumar SOMANI 7, Oivier TRAXER 8, Vineet GAUHAR 9 and Anna BUJONS 2
1) Marmara University School of Medicine, Urology, Istanbul, TURKEY - 2) Fundacio Puigvert, Paediatric Urology, Barcelona, SPAIN - 3) Marmara University School of Medicine, Paediatric Urology, Istanbul, TURKEY - 4) Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Urology, Ancona, ITALY - 5) Singapore General Hospital, Urology, Singapore, SINGAPORE - 6) National University of Singapore, Yong Loo Lin School of Medicine, Singapore, SINGAPORE - 7) University Hospital Southampton NHS Foundation Trust, Urology, Southampton, UNITED KINGDOM - 8) Hôpital Tenon, Urology, Paris, FRANCE - 9) Ng Teng Fong General Hospital, NUHS., Paediatric Urology, Singapore, SINGAPORE
PURPOSE
The utility of ureteral access sheath (UAS) is an important part of RIRS, but its efficacy and safety in children has been investigated in a small number of studies, with low patient volume. Our retrospective multicentric study aimed to compare outcomes in paediatric patients who underwent RIRS with UAS and those without UAS.
MATERIAL AND METHODS
Anonymized data from 8 centres were retrospectively evaluated. Inclusion criteria were children/adolescent patients (aged
RESULTS
Group 1 had 195 patients and group 2 of 194. The mean age of children without UAS was 8.73+/-4.75 years, children with UAS 9.96+/-4.67 (p<0.001). Symptoms at presentation were similar between two groups except hematuria (p<0.001). The mean stone diameter was significantly larger in Group 2 (11.59+/-4.85mm, 9.91+/-4.46mm, p=0.001). Operation time with or without postoperative stenting was shorter in group 1. Re-intervention rates for residual fragments were similar between groups. While the stone size and laser type were significant in univariate analysis, only stone size was significant in multivariate analysis (p<0.001, p=0.020, p=0.001, respectively).
CONCLUSIONS
RIRS can be performed safely in all patients with and without the use of UAS. UAS may be of greater utility in lithiasis larger than 1 cm, regardless of the age of the children, and by using smaller diameter we could decrease the number of complications. However, the use of UAS does not guarantee an improvement in the stone clearance rate.