Parallel Meeting on Thursday 4, September 2025, 11:10 - 12:05
11:10 - 11:13
S18-1 (OP)
Sadaf ABA UMER 1, Bashir AHMED 2, Sakina YOUSUF 2, Sajid SULTAN 2 and Adeeb Ul Hassan RIZVI 2
1) SINDH INSTITUTE OF UROLOGY AND TRANSPLANTATION, PHILIP G.RANSLEY DEPARTMENT OF PAEDIATRIC UROLOGY, Karachi, PAKISTAN - 2) SINDH INSTITUTE OF UROLOGY AND TRANSPLANTATION (SIUT), PHILIP G.RANSLEY DEPARTMENT OF PAEDIATRIC UROLOGY, Karachi, PAKISTAN
PURPOSE
PCNL is well established surgical modality for kidney stones. MPCNL has been considered to have less complications as compared to SPCNL in children but with its associated issues of increase operation-time and less stone free rate(SFR).Aim of the study is to compare the efficacy(in terms of SFR and operative-time)and safety(in terms of complications)of MPCNL and SPCNL in infants younger than two years of age.
MATERIAL AND METHODS
Retrospective review of medical record of infants(<=2years)who underwent PCNL between January2012-December2021.Data was reviewed for demography,stone size and volume, operative details,post-operative outcomes including SFR,need of blood transfusion and complications.Data was divided into two groups,Group-I,MPCNL(Sheath size <=16Fr.)and Group-II,SPCNL(Sheath size>=20Fr.).Statistical analysis was done on SPSS-v.20,Chi-square test,independent t-test and Mann-Whitney-U tests were used.P value<0.05 considered significant.
RESULTS
276 infants (332 RU) underwent PCNL between 2012-2021.
|
Group A MPCNL (<=16Fr.) n = 167 |
Group B SPNL (>=20 Fr.) n = 165 |
p-value | |
| Mean Age(y) | 1.59+/-0.42 | 1.54+/-0.44 | 0.29 |
| Mean Weight(kg) | 8.5+/-1.5 | 8.5+/-1.8 | 0.69 |
| M/F | 121/46 | 132/33 | 0.10 |
| Mean stone length(cm) | 1.9+/-0.68 | 1.9+/-0.70 | 0.99 |
| Mean Stone volume(cm2) | 3.0+/-2.0 | 2.8+/-2.2 | 0.27 |
|
Number of stones Single Multiple |
58(34.7%) 109(65.3%) |
59(35.8%) 106(64.2%) |
0.84 |
|
Approach Subcostal Supracostal |
117(70%) 50(30%) |
112(68.3%) 52(31.7%) |
0.32 |
| Mean-operative-Time(min) | 106.9+/-39.9 | 84.3+/-30.2 | 0.0001 |
| Stone free | 153(91.6%) | 157(95.2%) | 0.19 |
|
Complications CD-2 and above |
13(7.8%) |
10(6.1%) |
0.53 |
| Blood transfusion | 38(22.8%) | 39(23.6%) | 0.84 |
| Mean Pre-operative Hb(gm%) | 10.0+/-1.4 | 9.8+/-1.17 | 0.20 |
Mean Operative-time is significantly less in SPCNL as compared to MPCNL(p=0.0001) with almost similar stone free rate(n=0.19),complications(p=0.53) and blood transfusion rate(p=0.84) in both groups.
CONCLUSIONS
Both Mini PCNL and Standard PCNL are safe and effective in infants younger than 2 years with significantly less operative time in standard PCNL.
11:13 - 11:16
S18-2 (OP)
Youquan ZHAO, Chen NING and Jun LI
Beijing friendship hospital, Captical medical university, Urology, Beijing, CHINA
PURPOSE
This study aimed to compare the efficacy and safety of micro-PCNL and ultramini-PCNL in preschool chil dren with 10-20mm kidney stones.
MATERIAL AND METHODS
A retrospective analysis was performed on data from patients under 6 years who received micro-PCNL or ultramini-PCNL surgeries in our hospital between January 2020 and January 2024. The inclusion criteria consisted of pediatric patients (
RESULTS
There were 33 patients in the micro-PCNL group and 31 patients in the ultramini-PCNL group, with a mean age of 3.1±1.3 years and 3.6±1.8 years (p=0.208), respectively. The stone size was 15±4mm in the micro-PCNL group and 16±4mm in the ultramini-PCNL group (p=0.326). Micro-PCNL and ultramini-PCNL groups showed comparable stone-free rates (84.8% vs. 87.1%, p=0.796) and procedure times (49±17min vs. 54±23min, p=0.218). However, a significantly shorter hospitalization period was observed in the micro-PCNL group compared with the ultramini-PCNL group (2.3±1.3 days vs. 4.6±2.2 days, p < 0.001). Complications were similar between groups, with 12.4% in the micro-PCNL group and 16.1% in the ultramini-PCNL group and no severe hematuria was observed.
CONCLUSIONS
In preschool children with 10-20mm kidney stones, both micro-PCNL and ultramini-PCNL achieve similar high stone-free rates with minimal complications, showing comparable outcomes in appropriately selected patients with experienced surgeons.
11:16 - 11:19
S18-3 (OP)
Amr Kamal SALAMA 1, Ahmed ABD ELHAMEED 2, Omar EL SAGHIR 3, Ehab RAFAAT 4, Mahmoud EL SABBAGH 5, Ahmed EL DERWEY 6, Ahmed FAHMY 7, Haytham BADAWY 7 and Mohamed YOUSSIF 7
1) .Alexandria School of Medicine, Pediatric Urology, .Alexandrai, EGYPT - 2) Assiut School of Medicine, Urology, Assiut, EGYPT - 3) Qenna School of Medicine, Urology, Qenna, EGYPT - 4) Zagazig School Of Medicine, Pediatric Urology, Zagazig, EGYPT - 5) Alexandria University Hospital - Alexandria School of Medicineer, Urology, Alexandria, EGYPT - 6) Assiut School of Medicine, Pediatric Urology, Assiut, EGYPT - 7) Alexandria School of Medicine, Pediatric Urology, Alexandria, EGYPT
PURPOSE
Staghorn stones in children have shown a reported increase in incidence lately. The aim of this multicentric study was to evaluate the outcome of mini-PCNL in treating staghorn stones in children.
MATERIAL AND METHODS
Retrospective data of (64) patients who underwent mini-PCNL for staghorn stones from Jan-2022 to Sep-2024 were collected form four different tertiary centers and analyzed accordingly.
RESULTS
The mean age was (8.06 ± 4.39) years. The largest dimensions of treated stones were (28.17 ± 12.64)mm. The number of PCNL tracts were 1, 2 and 3 in 56, 7 and 1 patient respectively . A lower, middle and upper calyceal puncture was performed in 40 (62.5%) , 27 (42.2%) and 5 (7.8%) cases respectively. Average operative time was (65.80 ± 27.54) minutes. Hemoglobin drop was estimated to be (0.78 ± 0.68) g/dl. 12 patients (18.8%) required blood transfusion. Mean hospital stay was (2.67 ± 1.30) days . Complications occurred in 20 patients (31.3%) . According to the Clavien Dindo’s classification system, 9 (14.1%) , 4 (6.2%) , 12 (18.7%) patients had grade 1, 2 and 3 respectively.
Stone free status was achieved in 51 patients (79.7%) . 11 patients had residual fragments ≤10 mm and only 2 were >10 mm. One patient was managed conservatively while 12 patients (10.9%) required re-intervention. 5, 3, 3 and 1 patients underwent ESWL, RIRS, 2nd mini-PCNL and ECIRS respectively to achieve stone free status.
CONCLUSIONS
Mini-PCNL is very efficient and reliable to achieve stone free status in pediatric staghorn stones.
11:29 - 11:32
S18-4 (OP)
Alessandro MORLACCO 1, Michele GNECH 2, Paolo BELTRAMI 3, Martina BRUNIERA 4, Martina GROSSELE 3, Giovanni BASSO 3, Alfredo BERRETTINI 2 and Fabrizio DAL MORO 3
1) Urology Clinic, Urolgy, Padova, ITALY - 2) Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Pediatric Urology, Milano, ITALY - 3) Padova University Hospital, Urology, Padova, ITALY - 4) Padova University Hospital, Pediatric Urology, Padova, ITALY
PURPOSE
The EAU/ESPU do not provide clear-cut recommendation for the treatment of 1-2 cm intrarenal stones in the paediatric population. This study aims to describe the different strategies and outcomes in this specific population.
MATERIAL AND METHODS
We retrospectively enrolled patients from two large-volume centres from 2009 to 2022. Patients' and stone characteristics, details regarding treatment modalities, complications and stone-free-rates (SFR) were collected. We used descriptive statistics and Chi-square or Fisher-exact test for categorical variables.
RESULTS
96 patients were included, median age was 61 months (IQR 25- 105). 24 (25%) were treated under 2-years, 10 (10.4%) under 1-year. 19 (19.8%) had associated urological condition, 5 VUR and 4 previous pyeloplasty for UPJO. 50% of patients presented multiple stones. Median size of stones was 15mm (IQR 12-18 mm). 17 (17.7%) patients underwent SWL, 45 (46.9%) retrograde endourology (URS-RIRS), 19 (19.8%) PCNL, 8 (8.3%) open or VLS surgical treatment.
Intraoperative complication occurred in 4 (4.2%) patients (bleeding or urine leakage). 12 (12.5%) had early complications (fever), and 11 (11.5%) had late complications. 46 (47.9%) were stone free after 1st procedure, while 41 (42.7%) required more urological procedure (2 required 3 procedures). At 1st procedure, 10 ESWL patients (58.8%) were SFR, 22 (47.8%) URS-RIRS, 10 (52.6%) PCNL and 4 (57.1%) surgery, 1 underwent nephrectomy. 64 stones composition were analysed: 7 (7.3%) cystine, 2 (2.1%) uric-acid, 31 (32.3%) calcium, 24 (25%) mixed.
No significant differences in stone free rate were detected among different approaches, neither in early or late complications, nor in terms of calculi composition.
CONCLUSIONS
We did not find any significant difference in treatments for 1-2cm stones, and all the treatments are safe. This highlights the importance of personalised treatment, mastering different procedures. A truly tailored approach must consider position, presence of urological abnormalities or metabolic abnormalities that could determine stone resistance to treatment or recurrence.
11:32 - 11:35
S18-5 (OP)
Eduje THOMAS 1, Michele GNECH 1, Arianna ROGGERO 1, Alberto QUISTINI 1, Erika DE MARCO 1, Dario Guido MINOLI 2, Francesca MITZMAN 1, Francesca TARONI 1, Maria Cristina MANCUSO 1, Valentina CAPONE 1, Giovanni MONTINI 1 and Alfredo BERRETTINI 1
1) Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Paediatric Urology, Milano, ITALY - 2) Fondazione IRCCS Ca Granda -Ospedale Maggiore Policlinico, Paediatric Urology, Milano, ITALY
PURPOSE
According to current evidence in surgical treatment of stone disease, success is defined for residual fragments below 4mm. This study aims to define the destiny of postsurgical renal residual stones <9mm.
MATERIAL AND METHODS
Data regarding 167 patients treated between January 2010 and June 2024, with minimum follow-up of 6 months, was retrospectively reviewed. 81 residual stone fragments, not meeting criteria for second treatment, were identified and followed-up. Our main parameters were patients’ demographics, rates of regrowth, complication, spontaneous passage and re-operation.
RESULTS
The patients’ median age was 63 months (3-222 months). The median size of the residual stones was 6mm (2-9mm). 61 stones (75%) were in the lower calyces, 15 (19%) in the middle, 4 (5%) in the upper and 1 stone (1%) in the pelvis. Spontaneous passage was observed for 33 stones (41%) with a median size of 5mm (2-9mm) and in a median interval of 13 months. Ejected stones were in lower (73%), middle (18%), upper calyces (6%) and pelvis (3%). Twenty fragments (25%) showed a tendency to regrowth. Seventeen patients (21%) were re-operated during follow-up. Using logistic regression, we identified an optimal cut-off value of 6mm as predictive of spontaneous passage, although the model exhibits a poor performance (AUC=0,677). 49 residual stones (60%) were <6 mm and proved to be significantly associated with spontaneous passage and lower rates of clinical complications con chi-squared test (p<0,05).
CONCLUSIONS
According to our results, residual renal stones <6mm after surgery have good chances of spontaneous expulsion.
11:35 - 11:38
S18-6 (OP)
Sherjeel SAULAT, Umber RASHEED, Jahanzeb SHAIKH, Mansoor EJAZ and Syeda Sarah BATOOL
Tabba Kidney Institute, Urology, Karachi, PAKISTAN
PURPOSE
The purpose of the study was to assess if there is dire need of CT KUB in children under 15 yrs of age pre operatively who are undergoing PCNL for > 1 cm calculus.
MATERIAL AND METHODS
A total of 520 pediatric patients (< 15 yr of age) underwent prone PCNL were sorted into two groups, Group A included patients who were evaluated with CT KUB before PCNL, while Group B proceeded with PCNL with ultrasound KUB being sole pre-operative modality. Both groups on-table RPG. Mean age, stone size and location, intra-operative sheath size, pre and post-operative hemoglobin drop, need for blood transfusion, mean operative time, mean hospital stay and stone clearance was assessed; p value of < 0.05 was taken significant.
RESULTS
The mean age of the patients was 3.7 ± 2.3 years and 3.8 ± 3.9 years in group A and group B, respectively. Mean stone size in group A was 1.4 ± 0.1 while group B had 1.5 ± 0.1 cm. post-operative hemoglobin drop was comparable in both groups ; 1.2 ± 1.0 for group A and 1.5 ± 1.0 in group B. (p value- 0.08). Stone free rate was 98.9% in A and 99.2% in B.
CONCLUSIONS
Ultrasound KUB combined with on table RPG is safe and effective alternative to CT KUB in terms of stone clearance, minimal radiation exposure and cost effectiveness.
11:48 - 11:51
S18-7 (OP)
Francisco REED 1, Paola PEÑA 2, Gabriela SORRENTINO 1, Ivan CARO 3, Ximena RECABAL 1, Carlos FINSTERBUSCH 1, Nelly LETELIER 1 and Francisca YANKOVIC 1
1) Hospital Exequiel Gonzalez Cortes, Pediatric Urology, Santiago, CHILE - 2) Hospital Exequiel Gonzalez Cortes, Pediatric Surgery, Santiago, CHILE - 3) IMPRIMED, General, Santiago, CHILE
PURPOSE
The incidence of pediatric nephrolithiasis is increasing by 10% annually. Ultrasonography is the preferred initial diagnostic method, while non-contrast computed tomography (CT urography) remains the gold standard. Surgical treatment selection should consider stone anatomy and characteristics. Guidelines rely on stone volume estimation to determine the most effective approach. 3D modeling program may improve stone volume assessment. This study compares volumetric estimation using 3D modeling program versus traditional methods to optimize surgical decision-making.
MATERIAL AND METHODS
This retrospective descriptive study analyzed pediatric patients who underwent surgery for nephrolithiasis between October 2020 and August 2024. Inclusion criteria: preoperative evaluation with CT urography. Exclusion criteria: age >16 years, kidney transplant. Using 3D modeling software (3-matic®), stone volume was estimated and compared with traditional methods (Ackerman formula, surface area, and spherical volume) to determine stone burden. Descriptive statistics were applied.
RESULTS
Eight patients were analyzed (mean age: 8 years). The mean stone diameter was 10.5 mm (range: 4.3-20 mm). Average measurements using traditional methods were: 73.35 mm² (Ackerman), 295.62 mm² (surface area), and 1085 mm³ (spherical volume). In contrast, 3D modeling yielded an average of 274.96 mm² and 75.84 mm³. Compared to 3D modeling program, Ackerman method underestimated stone burden by 172.35 mm², while the spherical surface area and volume overestimated it by 157.41 mm² and 811.58 mm³, respectively.
CONCLUSIONS
3D modeling program provides a larger volume estimate than Ackerman method but significantly lower than spherical surface and volume estimates. This technique may offer more accurate stone burden assessment in pediatric nephrolithiasis compared to traditional methods, improving surgical timing and approach based on clinical guidelines.
11:51 - 11:56
S18-8 (VP)
Mehmet Ugur YILMAZ 1, Ozgur EKICI 2, Oguzcan Taha DEMIRGOZ 2, Ismail GUNGOR 3 and Sedat ONER 2
1) Bursa City Hospital, Paediatric Urology, Bursa, TÜRKIYE - 2) Bursa City Hospital, Urology, Bursa, TÜRKIYE - 3) Bursa City Hospital, Paediatric Surgery, Bursa, TÜRKIYE
PURPOSE
Percutaneous nephrolithotomy can be technically challenging in patients with complex anatomy. This report describes a case of multiple-access left PCNL(percutaneous nephrolithotomy) in a child with severe scoliosis, spina bifida, and a solitary kidney containing a staghorn calculus.
MATERIAL AND METHODS
A 16-year-old child presented with a staghorn calculus in a solitary left kidney, along with spina bifida, scoliosis, and a non-functioning right kidney. Preoperative imaging, including KUB(kidney, ureter, and bladder) radiography, revealed stones superimposed on the vertebrae. DMSA(dimercaptosuccinic acid) scan demonstrated 89% function in the left kidney, and CT(computed tomography) scan confirmed multiple stones filling renal pelvis and most calyces. Due to lower extremity contractures that do not allow adduction, cystoscopy and ureteral catheter placement was performed in a modified position. The patient was then placed prone with similar modification for PCNL. Multiple access tracts were created to achieve complete stone clearance. A double-J(DJ) stent was placed antegrade fashion and a nephrostomy tube was placed through one tract.
RESULTS
All stone fragments were successfully removed. Postoperative antegrade pyelography showed no extravasation except at access sites. A nephrostomy tube was placed, and postoperative KUB confirmed a stone-free kidney. The nephrostomy tube was removed on the 8th postoperative day. DJ stent was removed in the first postoperative month. He is currently in the 5th month postoperatively and is being followed up without any problems.
CONCLUSIONS
This case demonstrates the feasibility of successful multiple-access PCNL in a child with challenging anatomy, highlighting the importance of careful preoperative planning and intraoperative adaptation.