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495 Is there still a need to puncture the kidney for treating large stones in pediatric kidney?
Title
495
Is there still a need to puncture the kidney for treating large stones in pediatric kidney? Eur Urol Suppl 2015;14/2;e495
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Attallah H., Mokhles I., Yousef M., Fahmi A., Said M. Alexandria, Dept. of Urology, Alexandria, Egypt INTRODUCTION & OBJECTIVES: We present our experience in management of large or complex renal stones in pediatrics more than 2 cm using stepladder approach starting by semi rigid ureteroscopy, Flexible ureteroscopy and Holmium laser then simultaneous combined minimally invasive supine percutaneous nephrolithotomy (MSPCNL) and retrograde intrarenal surgery (RIRS), and evaluate the indication, safety, efficiency and feasibility of these approaches MATERIAL & METHODS: The study included 34 patients (35 renal units) with large or complex renal stones more than 2 cm in pediatrics. Demographic characteristics, stone location and surface area were recorded. After informed consent, the patients underwent firstly one stage semi rigid ureteroscopy, when needed we use Flexible ureteroscopy for complex procedures or inaccessible calyces then simultaneous MSPCNL and RIRS. Operative parameters, stone-free rate (SFR), stone analyses and complications were evaluated. The mean stone size was 25 mm. The mean whole operative duration was 57 minute final SFR was 100%. RESULTS: A total of 34 children registered from March 2013 to July 2014 in Urology Department Alexandria University. The boys: girls ratio was 1:1.26 and mean age 4.4 years. Normal anatomy of Upper urinary tract in all patients except for two patients with one HorseShoe kidney and the other malrotated kidney. In 16 patients (47%) semi rigid ureteroscopy was enough for complete cure of pelvic stones. In 9 patients (26.47%) with pure middle and /or lower calycle stones flexible ureteroscopy after passive dilatation by semi rigid ureteroscopy without access sheath was helpful. In 9 patients (26.47%) with multiple pelvic and lower calycle stones simultaneous MSPCNL and RIRS were done. Success rate was evaluated, as total absence of lithiasic residuals was 100% at the time of Double-J stent removal. We reported 1 case of intraoperative complication case of perforation and extravasation at the ureterovesical junction after stage of semi rigid ureteroscopy that was managed with stent placement. CONCLUSIONS: Semi rigid and Flexible ureteroscopy can give a good access to the kidney throw the ureter, Combined MSPCNL and RIRS management effectively decrease the number and size of percutaneous access tracts, which is safe, feasible, and efficient for managing calculi in pediatrics kidney with satisfactory SFR and reducing blood loss, potential morbidity associated with multiple tracts.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/495.html[19/02/2015 08:14:33]
495
Is there still a need to puncture the kidney for treating large stones in pediatric kidney? Eur Urol Suppl 2015;14/2;e495
Print! Print!
Attallah H., Mokhles I., Yousef M., Fahmi A., Said M. Alexandria, Dept. of Urology, Alexandria, Egypt INTRODUCTION & OBJECTIVES: We present our experience in management of large or complex renal stones in pediatrics more than 2 cm using stepladder approach starting by semi rigid ureteroscopy, Flexible ureteroscopy and Holmium laser then simultaneous combined minimally invasive supine percutaneous nephrolithotomy (MSPCNL) and retrograde intrarenal surgery (RIRS), and evaluate the indication, safety, efficiency and feasibility of these approaches MATERIAL & METHODS: The study included 34 patients (35 renal units) with large or complex renal stones more than 2 cm in pediatrics. Demographic characteristics, stone location and surface area were recorded. After informed consent, the patients underwent firstly one stage semi rigid ureteroscopy, when needed we use Flexible ureteroscopy for complex procedures or inaccessible calyces then simultaneous MSPCNL and RIRS. Operative parameters, stone-free rate (SFR), stone analyses and complications were evaluated. The mean stone size was 25 mm. The mean whole operative duration was 57 minute final SFR was 100%. RESULTS: A total of 34 children registered from March 2013 to July 2014 in Urology Department Alexandria University. The boys: girls ratio was 1:1.26 and mean age 4.4 years. Normal anatomy of Upper urinary tract in all patients except for two patients with one HorseShoe kidney and the other malrotated kidney. In 16 patients (47%) semi rigid ureteroscopy was enough for complete cure of pelvic stones. In 9 patients (26.47%) with pure middle and /or lower calycle stones flexible ureteroscopy after passive dilatation by semi rigid ureteroscopy without access sheath was helpful. In 9 patients (26.47%) with multiple pelvic and lower calycle stones simultaneous MSPCNL and RIRS were done. Success rate was evaluated, as total absence of lithiasic residuals was 100% at the time of Double-J stent removal. We reported 1 case of intraoperative complication case of perforation and extravasation at the ureterovesical junction after stage of semi rigid ureteroscopy that was managed with stent placement. CONCLUSIONS: Semi rigid and Flexible ureteroscopy can give a good access to the kidney throw the ureter, Combined MSPCNL and RIRS management effectively decrease the number and size of percutaneous access tracts, which is safe, feasible, and efficient for managing calculi in pediatrics kidney with satisfactory SFR and reducing blood loss, potential morbidity associated with multiple tracts.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/495.html[19/02/2015 08:14:33]