ESPU Meeting on Saturday 20, April 2024, 09:45 - 10:25
09:48 - 09:51
S23-2 (OP)
Mahmoud ELSABBAGH, Amr SALAMA, Waleed DAWOOD, Ahmed FAHMY, Haytham BADAWY and Mohamed YOUSSIF
Alexandria University Hospital - Alexandria School of Medicine, Pediatric Urology, Alexandrai, EGYPT
PURPOSE
Ultrasound (US) guidance has shown its advantages over fluoroscopy-only in renal access. The main aim of this study is to assess the reduction in fluoroscopy time using fluoroscopy (FL) assisted (US) guidance compared to the mere use of fluoroscopy in mini-PCNL in children.
MATERIAL AND METHODS
Prospective randomized study was performed on 50 consecutive patients undergoing mini-PCNL from July 2022 to August 2023. Patients were divided into 2 groups (25 each). In (Group 1), patients underwent fluoroscopy only guided puncture while in (group 2) patients had (FL) assisted (US) guided puncture. Demographic data, puncture time, fluoroscopy time, stone-free rate and complication rate were analyzed.
RESULTS
Median age in group 1 compared to group 2 was (7.0 (5.75-10.0) vs. 7.50 (5.0-11.0)) years. Fluoroscopy time was significantly reduced when ultrasound guidance was added; from (157.9 ± 68.54) seconds in group 1 to (29.44 ± 17.01) seconds in group 2 (p < 0.05). Radiation dose was reduced from (32.35 ± 13.79) mGy in group 1, to (6.07 ± 3.57) mGy in group 2 (p < 0.05). Time to puncture was reduced from (136.6 ± 50.78) (sec) in group 1, to 52.20 ± 33.20 (sec) in group 2 (p < 0.05). Global Stone free rate was 95.3% with no statistical difference. Complications rate in group 1 was 32% compared to 20% in group 2 with no statistical difference (p 0.653).
CONCLUSIONS
(FL) assisted (US) guidance in renal access is a safe and efficient technique compared to fluoroscopy only technique in mini PCNL in children.
09:51 - 09:54
S23-3 (OP)
Ahmad A ELDERWY 1, Islam F ABDELKAWI 1, Ahmed SERAG 1, Islam F ABDELKAWI 1, Ayman ELQADY 1, Hassan ABOULELLA 1, Mohamed Atef ABDELAZIZ 1, Guohua ZENG 2 and Ahmed SHAHAT 1
1) ASSIUT UNIVERSITY, UROLOGY, Assiut, EGYPT - 2) GUANGZHOU UNIVERSITY, UROLOGY, Guangzhou, CHINA
PURPOSE
To evaluate the feasibility of ultrasound-only-guided mini-percutaneous nephrolithotomy (mini-PNL) and to compare it to standard mini-PNL in pediatric patients.
MATERIAL AND METHODS
This randomized comparative trial (NCT03250559) included 60 renal units in 57 children ≤14 years with renal stones >1 cm. Mini-PNL was done under ultrasound guidance in 30 renal units and under fluoroscopy guidance in the other 30. The two groups were compared regarding baseline criteria, operative details and postoperative outcomes. Stone free rate (SFR) was defined as ≤ 3 mm residual fragments according to post-operative non-contrast computed tomography (NCCT) scan. The patients were followed for at least 2 years.
RESULTS
In the ultrasound group (USG); fluoroscopy was needed in 4 cases while in the fluoroscopy group (FG); ultrasound was needed in two cases (p=0.67).
Both groups were comparable regarding baseline criteria and operative details except that the USG had significantly more dilated tracts (p=0.021), and more supra-costal tracts (p=0.002).
As revealed by the initial postoperative NCCT, 66.7% in the USG and 83.3% in the FG were rendered stone-free (p=.23). After exclusion of Guy III cases (5 cases), the initial SFR increased to 76.9% in the USG and 86.2% in the FG (p=.49). Although both intra-operative and postoperative complications were comparable between the two groups, hospital stay was significantly longer (2.5 vs. 2 days) in the USG (p=.010).
CONCLUSIONS
Solo ultrasonographic guidance of mini-PNL in children is feasible and yields comparable outcomes to fluoroscopic guidance specially for Guy I/II cases. On-demand fluoroscopy should be always accessible to cover the shortcomings of ultrasonography in tract dilation and detection of residuals.
10:05 - 10:08
S23-4 (OP)
Bashir AHMED 1, Sadaf ABA UMAR 2, Sajid SULTAN 2 and Adib-Ul-Hassan RIZVI 2
1) Sindh Institute of Urology & transplantation, Philips G Rensley Department of Paediatric Urology, Karachi, PAKISTAN - 2) Sindh Institute of Urology & transplantation, Philip G Ransley Department of Paediatric Urology, Karachi, PAKISTAN
PURPOSE
To compare the safety, efficacy and outcome of Ultrasound V/S fluoroscopy-guided prone mini PCNL in paediatric age group.
MATERIAL AND METHODS
Retrospective analysis of medical Records of children who underwent Prone mini PCNL under ultrasound-guidance and fluoroscopy-guidance from 15thJune 2022 to 16thJune 2023. In all 92 renal units(88 patients) were included both Group I ultrasound-guided and Group II fluoroscopy-guided had 46 renal units each record were reviewed and compared for age, gender, stone-laterality, single or multiple stones, puncture-site, operative-time, blood-transfusion, complication, hospital-stay, and stone-clearance. Statistical analysis was done on SPSSv.20.0. Independent t-test, and Chi-square test were used for statistical analysis. p-value<0.05 was considered significant.
RESULTS
M:F 1.3:1
|
Mean age 6.1+/-2.6yrs |
Ultrasound-guided Group I Mean age 6.1+/-2.6yrs N=46 |
Fluoroscopy-guided Group II Mean age 6.1+/-2.7yrs N=46 |
P=Value |
|
Stone size (cm) |
2.2+/-0.67 |
2.3+/-0.76 |
0.61 |
|
Single stones |
30(65%) |
27(59%) |
0.83 |
|
Multiple stones |
16(35%) |
19(41%) |
|
|
Supracostal puncture |
23(50%) |
18(39%) |
0.29 |
|
Subcostal puncture |
23 (50%) |
28(61%) |
|
|
Posterior Superior calyx puncture |
33(72%) |
13(28%) |
|
|
Posterior Inferior calyx puncture |
33(72%) |
12926%) |
0.22 |
|
Posterior superior & inferior calyces |
00 |
1(2.1%) |
|
|
Operative time (min) |
66.45+/-24.7 |
63+/-28.3 |
0.26 |
|
Stone clearance |
43(93.5%) |
39(85%) |
0.18 |
|
Mean hospital stay (days) |
2.7+/-1.0 |
3.4+/-3.3 |
0.073 |
|
Postoperative blood transfusion |
9(19.5%) |
8(17.3%) |
0.78 |
|
Postoperative complication |
15(32%) |
15(32%) |
1.0 |
The stone-size and stone-free rates are comparable between the groups. Over all complications clavian Dindo(I) 22(24%) clavian Dindo(II) 9(9.7%) and clavian Dindo(III) 4(4.39%).
CONCLUSIONS
This study showed that ultrasound-guided mini PCNL has a similar efficacy and complication rate to fluoroscopy-guided mini PCNL. However, ultrasound-guided puncture gives real-time simultaneous bi-plane tracking of the route of puncture into the desired calyx and prevents the hazard of radiation to the patient, and operative team.
10:08 - 10:11
S23-5 (OP)
Thomas LOUBERSAC 1, Fabrizio VATTA 2, Hortense ALLIOT 2, Karim BRAIK 3, Xavier DELFORGE 4, Marc BARRAS 5, Sebastien FARAJ 2 and Marc-David LECLAIR 2
1) University Hospital of Nantes, Paediatric Urology, Nantes, FRANCE - 2) University Hospital of Nantes, Pediatric urology, Nantes, FRANCE - 3) UNIVERSITY HOSPITAL OF TOURS, Pediatric urology, Tours, FRANCE - 4) UNIVERSITY HOSPITAL OF Amiens, Pediatric urology, Amiens, FRANCE - 5) UNIVERSITY HOSPITAL OF Brest, Pediatric urology, Brest, FRANCE
PURPOSE
Percutaneous surgery is the recommended treatment for kidney stones >2cm. Results seem worst
in children under 6 years of age. We wanted to compare the results of mini-PCNL for the treatment of kidney stones >2cm between children >6 years (group A) and children <or=6 years (group B) in our centre.
MATERIAL AND METHODS
We prospectively included all children who underwent surgery at our centre from 2018 to 2023.
of mini-PCNL<15F for renal calculi >2cm (or>10mm for inferior calculi) and analysed retrospectively. We compared outcomes and complications between
between group A and group B.
The primary endpoint was 3-month stone free(SF) status, defined as the absence of a residual fragment >4mm on post-operative imaging.
RESULTS
33 procedures (group A n=15 and group B n=18) were performed in 25 patients (group A n=13 and group B n= 12 with 2 patients had bilateral procedures). The demographic were not statistically different between the two groups except for age and weight. The median(IQR) age in group A was 12 years (11;14) and in group B 3years (2;4). Median(IQR) cumulative stone size was 26mm (19;34) in group A and 35mm (25;50) in group B (p=0.05).
The SF rate after one procedure was 66% (10/15) in group A and 66% (12/18) in group B (p=0.8). Median(IQR) Length of procedure (Group A n= 139min (94;152) and Group B n=128min (110;158)) , hospital stay and follow-up (Group A n= 25 months(15;39) and Group B n=19 months(14;28)) were not statistically different between the two groups . There were 2 complications in group A and 3 complications in group B > or= Clavien 3.
CONCLUSIONS
According to our series, the results of mini-PCNL in children > or < 6 years of age appear to be comparable and would allow a high rate of SF with few complications despite large stone sizes.
10:11 - 10:14
S23-6 (OP)
Yesica QUIROZ MADARRIAGA 1, Stefania FERRETTI 2, Davide CAMPOBASSO 2, Claudia GATTI 2, Francesca CARAVAGGI 2, Rocio JIMENEZ 1, Erika LLORENS 1 and Anna BUJONS 1
1) Fundacio Puigvert, Paediatric Urology, Barcelona, SPAIN - 2) Azienda Ospedaliero-Universitaria of Parma, Urology, Parma, ITALY
PURPOSE
Endoscopic combined intrarenal surgery (ECIRS) is a combination of both retrograde and antegrade approaches for treatment of large or complex renal stones in one procedure, that are currently being treated with multiple tracts or sessions of PCNL, increasing the complications. The aim of our study is describe the clinical outcomes of ECIRS in a pediatric population.
MATERIAL AND METHODS
A retrospective study was performed in pediatric patients with lithiasis disease treated with ECIRS between 2006 and 2023 in 2 referral centers in Europe. 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
30 patients were included. The mean age was 9,7 years, 56,7% girls. The mean size of the
stone was 21,7mm (12-77 mm), 53,33% were multiple. Ureteral access sheath (UAS) was used in 93,3% of the surgeries and only 36,7% had preoperative JJ stent. 86,7% of percutaneous access were MiniPCNL (14-20Fr). High power laser (HPL) was the most frequent energy source for lithotripsy, including TFL. The most commonly used settings were 10-30Hz and 0.8-3J. The mean operative time was 162 minutes. There was one perforation of the collecting system that was managed with JJ stent and in the postoperative period 83.33% of the patients had no complications. 3 presented fever, 1 developed urinary sepsis and 1 required reintervention. The SFR was 70% and the lithiasis size was statistically significant (p 0.018).
CONCLUSIONS
ECIRS is a feasible, safe and efficient procedure in children with complex renal lithiasis, decreasing the number of procedures needed for stone free. Multicenter studies are required to validate these results on a population scale.