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Clinical Application of a New Pediatric Ureterorenoscope
ESPU Programme 2008
S83
# V-13 (V) LAPAROSCOPIC REVISION OF A MALFUNCTIONING PERITONEAL DIALYSIS CATHETER IN AN INFANT: A HARD CASE Omer OGE, Burcin OZEREN* Kent Hospital, Dept. of Urology, Izmir, TURKEY - *Adnan Menderes University, urology, Aydin, TURKEY
PURPOSE This video shows the laparoscopic management of a malfunctioning Tenckhoff peritoneal dialysis catheter and the release of extensive intraperitoneal adhesions in 5 months old and 4200 grams male infant.
MATERIAL AND METHODS The baby was on continuous ambulatory peritoneal dialysis program since the first month of life due to bilateral multicystic dysplastic kidney disease and his history had: peritonitis twice; Tenckhoff catheter replacement once and repositioning twice; omentectomy; hydrocelectomy and inguinal
hernia repair. 15 days old Tenckhoff catheter was obstructed and the blood K+ was 6.1 mEq/ml. So, it was decided to salvage the Tenckhoff catheter laparoscopically.
repositioned. Intraperitoneum was irrigated with antibiotics and heparin. Total operative time was 1 hour by 2 ports and the patient returned to peritoneal dialysis 8 hours from the operation.
RESULTS
CONCLUSIONS
A laparoscope was introduced with open port technique and extensive peritoneal adhesions were seen and the Tenckhoff catheter was also enveloped by fibrotic tissue and wrapped by the colon tightly. Intraperitoneal adhesions were freed, the colon was unwrapped and the catheter was taken out the fibrous sheath. After achieving correct outflow, Tenckhoff catheter was
Laparoscopy, for which previous abdominal surgery and intraperitoneal adhesions are accepted as relative contraindications, could be performed successfully by open port technique in a 4200 gr. infant with extensive intraperitoneal adhesions. This procedure should be accepted as lifesaving by the advantage of immediate return of the peritoneal dialysis.
# V-14 (V) CLINICAL APPLICATION OF A NEWLY DEVELOPED URETERO-RENOSCOPE FOR PEDIATRIC USE Wouter FEITZ, Pieter HEST, Martijn STEFFENS, B. KORTMANN*, R. DE GIER* Radboud University Nijmegen MC, Pediatric Urology, Nijmegen, NETHERLANDS - *Radboud University Nijmegen, Pediatric Urology, Nijmegen, NETHERLANDS
PURPOSE
MATERIAL AND METHODS
RESULTS
Together with Storz (Karl Storz GmbH & Co., Tuttlingen, Germany) we developed a new semirigid ureterorenoscope for pediatric use. This ureterorenoscope was used in several clinical cases with succes who could not have been treated in this way before. In this video we present the treatment and endoscopic pictures of one girl with a large stone.
A 9 years old girl with a proximal ureteric calculus of 10 mm is treated with this scope using a Holmium-YAG laser, the LithoClast and a grasper. The new ureterorenoscope is build according to the following specifications: length: 25 cm (9.8 inch), full length diameter: 7.3 Char/Fr, single channel, atraumatic tip, angled or straight eyepiece.
The calculus is succesfully disintegrated and the bigger parts are removed. An ureteral stent is placed to facilitate the evacuation of small stone-parts. No complications occurred. The short shaft makes it easier to handle and navigate through the ureter, which reduces the risk of ureteral damage.
CONCLUSIONS We demonstrate the use and possibilities of this new uretero-renoscopic (25cm, 7,3 Fr.) instrument designed for pediatric use.
# V-15 (V) CLINICAL APPLICATION OF A NEW PEDIATRIC URETERORENOSCOPE Pieter VAN HEST, Martijn STEFFENS, Wout FEITZ Radboud University Nijmegen Medical Centre, Urology, Nijmegen, NETHERLANDS
PURPOSE
MATERIAL AND METHODS
Together with Storz (Karl Storz GmbH & Co., Tuttlingen, Germany) we developed a new semirigid ureterorenoscope for pediatric use.
A 9 years old girl with a proximal ureteric calculus of 10 mm is treated with this scope using a Holmium-YAG laser, the LithoClast and a grasper. The new ureterorenoscope is
build according to the following specifications: length: 25 cm (9.8 inch), full length diameter: 7.3 Fr, single 3 Fr channel, atraumatic tip, angled or straight eyepiece.
S84 RESULTS The calculus is succesfully disintegrated and the bigger parts are removed. An ureteral stent is placed to facilitate the evacuation
ESPU Programme 2008 of small stone-parts. No complications occurred. The short and small size shaft makes is easier to handle and navigate through the ureter in children, which reduces the risk of ureteral damage.
CONCLUSIONS We demonstrate the use and possibilities of this new instrument specially designed for applications in children.
# V-16 (V) BILATERAL LAPAROSCOPIC HEMINEPHRECTOMY IN A CHILD WITH BILATERAL ECTOPIC URETER: THE CASE FOR MINIMAL INVASIVE SURGERY Gilmar GARRONE, Flavio IIZUCA, Tiago ROSITO, Jesus PIRES, Endric HASEGAWA, Riberto LIGUORI, Antonio MACEDO JR, Valdemar ORTIZ UNIFESP, UROLOGY, Sao Paulo, BRAZIL
PURPOSE The laparoscopic approach is regarded today as an excellent option for renal ablative and reconstructive surgery in adults and older children. In case of bilateral renal surgery it has potential advantages over open surgery in terms of morbidity, use of analgesics and recovery. We present a video of a child with bilateral ectopic ureter treated by simultaneous bilateral laparoscopic heminephrectomy.
MATERIAL AND METHODS
duplicity and upper pole hydronephrosis, presenting with insensitive urinary loss with preserved micturitions and breakthrough UTI. The patient was positioned in oblique dorsal 45 degrees decubitus and a transperitoneal approach with 4 ports was made (2 of 12mm and 2 of 5mm). The dilated ureter was identified at the distal third and cranially dissected up to the upper renal pole and ressected with selective clamping of arterial branch. After decubitus change the same procedure was performed for the other side. The distal ureter stumpf was left open after urin aspiration.
RESULTS The surgery took 480 minutes, with approximately 220 minutes for each side and 40 minutes for repositioning the patient. The clinical evolution was uneventful, the patient was dismissed on the 4th postoperative day totally dry.
CONCLUSIONS We believe that transperitoneal laparoscopic approach is the option of choice for bilateral heminephrectomy also in children.
We present a case of a 6 year old female patient with bilateral complete renal
# V-17 (V) USE OF RETROPERITONEOSCOPIC INTRACORPOREAL LITHOTRIPTER IN THE TREATMENT OF NEPHROLITHIASIS IN CHILDREN Rosa MARTı´N-CRESPO, Rafael LUQUE MIALDEA complejo hospitalario de Toledo, pediatric urology, Toledo, SPAIN
PURPOSE The objective is to assess the efficacy of intracorporeal lithotripsy (StoneBreaker) by retroperitoneoscopical approach for treating pediatric struvita stones in the renal pelvis.
ultrasonography. The calculi were located in renal pelvis and inferior caliceal group, with associated mild hydronephrosis. Retroperitoneoscopy was the minimally invasive method perfomed to access to the pelvic stone. Stone clearance was documented on a radiograph taken the day after the surgery.
38, respectively. The renal pelvis was closed and a Penrose drain was left in the retroperitoneum. In the 2 patients a doubleJ stent was maintained postoperatively. The hospital stay was 3 days. Both patients (100%) became stone free.
RESULTS
CONCLUSIONS
2 patients had retroperitoneoscopy approach by 3 ports. The size of the stones was 3 and 4,2 cm, respectively. Surgical technique is described. Lithotripsy was continued until stone fragmentation was sufficient to permit safe and easy removal of all fragments. Any evidencce of urothelial trauma was noted. The number of shocks required for successful clearance was 25 y
The StoneBreaker appears to be an effective portable intracorporeal lithotripter that should plays an important role among endourological options for lithotripsy in children. Retroperitoneoscopy is an effective, minimally invasive, low-morbidity alternative to open nephrolitotomy for treatment of pelvicaliceal complex stones in the pediatric age.
MATERIAL AND METHODS We have treated two patients with unilateral pelvic struvita calculi using the StoneBreaker, a novel device, portable contact pneumatic intracorporeal lithotripter. The age at surgery was 2 and 4 years old. The patients presented with abdominal pain, nausea and vomiting and recurrent urinary tract infection due to Proteus and Pseudomona spp. Diagnosis was made by plain radiographs and renal
S83
# V-13 (V) LAPAROSCOPIC REVISION OF A MALFUNCTIONING PERITONEAL DIALYSIS CATHETER IN AN INFANT: A HARD CASE Omer OGE, Burcin OZEREN* Kent Hospital, Dept. of Urology, Izmir, TURKEY - *Adnan Menderes University, urology, Aydin, TURKEY
PURPOSE This video shows the laparoscopic management of a malfunctioning Tenckhoff peritoneal dialysis catheter and the release of extensive intraperitoneal adhesions in 5 months old and 4200 grams male infant.
MATERIAL AND METHODS The baby was on continuous ambulatory peritoneal dialysis program since the first month of life due to bilateral multicystic dysplastic kidney disease and his history had: peritonitis twice; Tenckhoff catheter replacement once and repositioning twice; omentectomy; hydrocelectomy and inguinal
hernia repair. 15 days old Tenckhoff catheter was obstructed and the blood K+ was 6.1 mEq/ml. So, it was decided to salvage the Tenckhoff catheter laparoscopically.
repositioned. Intraperitoneum was irrigated with antibiotics and heparin. Total operative time was 1 hour by 2 ports and the patient returned to peritoneal dialysis 8 hours from the operation.
RESULTS
CONCLUSIONS
A laparoscope was introduced with open port technique and extensive peritoneal adhesions were seen and the Tenckhoff catheter was also enveloped by fibrotic tissue and wrapped by the colon tightly. Intraperitoneal adhesions were freed, the colon was unwrapped and the catheter was taken out the fibrous sheath. After achieving correct outflow, Tenckhoff catheter was
Laparoscopy, for which previous abdominal surgery and intraperitoneal adhesions are accepted as relative contraindications, could be performed successfully by open port technique in a 4200 gr. infant with extensive intraperitoneal adhesions. This procedure should be accepted as lifesaving by the advantage of immediate return of the peritoneal dialysis.
# V-14 (V) CLINICAL APPLICATION OF A NEWLY DEVELOPED URETERO-RENOSCOPE FOR PEDIATRIC USE Wouter FEITZ, Pieter HEST, Martijn STEFFENS, B. KORTMANN*, R. DE GIER* Radboud University Nijmegen MC, Pediatric Urology, Nijmegen, NETHERLANDS - *Radboud University Nijmegen, Pediatric Urology, Nijmegen, NETHERLANDS
PURPOSE
MATERIAL AND METHODS
RESULTS
Together with Storz (Karl Storz GmbH & Co., Tuttlingen, Germany) we developed a new semirigid ureterorenoscope for pediatric use. This ureterorenoscope was used in several clinical cases with succes who could not have been treated in this way before. In this video we present the treatment and endoscopic pictures of one girl with a large stone.
A 9 years old girl with a proximal ureteric calculus of 10 mm is treated with this scope using a Holmium-YAG laser, the LithoClast and a grasper. The new ureterorenoscope is build according to the following specifications: length: 25 cm (9.8 inch), full length diameter: 7.3 Char/Fr, single channel, atraumatic tip, angled or straight eyepiece.
The calculus is succesfully disintegrated and the bigger parts are removed. An ureteral stent is placed to facilitate the evacuation of small stone-parts. No complications occurred. The short shaft makes it easier to handle and navigate through the ureter, which reduces the risk of ureteral damage.
CONCLUSIONS We demonstrate the use and possibilities of this new uretero-renoscopic (25cm, 7,3 Fr.) instrument designed for pediatric use.
# V-15 (V) CLINICAL APPLICATION OF A NEW PEDIATRIC URETERORENOSCOPE Pieter VAN HEST, Martijn STEFFENS, Wout FEITZ Radboud University Nijmegen Medical Centre, Urology, Nijmegen, NETHERLANDS
PURPOSE
MATERIAL AND METHODS
Together with Storz (Karl Storz GmbH & Co., Tuttlingen, Germany) we developed a new semirigid ureterorenoscope for pediatric use.
A 9 years old girl with a proximal ureteric calculus of 10 mm is treated with this scope using a Holmium-YAG laser, the LithoClast and a grasper. The new ureterorenoscope is
build according to the following specifications: length: 25 cm (9.8 inch), full length diameter: 7.3 Fr, single 3 Fr channel, atraumatic tip, angled or straight eyepiece.
S84 RESULTS The calculus is succesfully disintegrated and the bigger parts are removed. An ureteral stent is placed to facilitate the evacuation
ESPU Programme 2008 of small stone-parts. No complications occurred. The short and small size shaft makes is easier to handle and navigate through the ureter in children, which reduces the risk of ureteral damage.
CONCLUSIONS We demonstrate the use and possibilities of this new instrument specially designed for applications in children.
# V-16 (V) BILATERAL LAPAROSCOPIC HEMINEPHRECTOMY IN A CHILD WITH BILATERAL ECTOPIC URETER: THE CASE FOR MINIMAL INVASIVE SURGERY Gilmar GARRONE, Flavio IIZUCA, Tiago ROSITO, Jesus PIRES, Endric HASEGAWA, Riberto LIGUORI, Antonio MACEDO JR, Valdemar ORTIZ UNIFESP, UROLOGY, Sao Paulo, BRAZIL
PURPOSE The laparoscopic approach is regarded today as an excellent option for renal ablative and reconstructive surgery in adults and older children. In case of bilateral renal surgery it has potential advantages over open surgery in terms of morbidity, use of analgesics and recovery. We present a video of a child with bilateral ectopic ureter treated by simultaneous bilateral laparoscopic heminephrectomy.
MATERIAL AND METHODS
duplicity and upper pole hydronephrosis, presenting with insensitive urinary loss with preserved micturitions and breakthrough UTI. The patient was positioned in oblique dorsal 45 degrees decubitus and a transperitoneal approach with 4 ports was made (2 of 12mm and 2 of 5mm). The dilated ureter was identified at the distal third and cranially dissected up to the upper renal pole and ressected with selective clamping of arterial branch. After decubitus change the same procedure was performed for the other side. The distal ureter stumpf was left open after urin aspiration.
RESULTS The surgery took 480 minutes, with approximately 220 minutes for each side and 40 minutes for repositioning the patient. The clinical evolution was uneventful, the patient was dismissed on the 4th postoperative day totally dry.
CONCLUSIONS We believe that transperitoneal laparoscopic approach is the option of choice for bilateral heminephrectomy also in children.
We present a case of a 6 year old female patient with bilateral complete renal
# V-17 (V) USE OF RETROPERITONEOSCOPIC INTRACORPOREAL LITHOTRIPTER IN THE TREATMENT OF NEPHROLITHIASIS IN CHILDREN Rosa MARTı´N-CRESPO, Rafael LUQUE MIALDEA complejo hospitalario de Toledo, pediatric urology, Toledo, SPAIN
PURPOSE The objective is to assess the efficacy of intracorporeal lithotripsy (StoneBreaker) by retroperitoneoscopical approach for treating pediatric struvita stones in the renal pelvis.
ultrasonography. The calculi were located in renal pelvis and inferior caliceal group, with associated mild hydronephrosis. Retroperitoneoscopy was the minimally invasive method perfomed to access to the pelvic stone. Stone clearance was documented on a radiograph taken the day after the surgery.
38, respectively. The renal pelvis was closed and a Penrose drain was left in the retroperitoneum. In the 2 patients a doubleJ stent was maintained postoperatively. The hospital stay was 3 days. Both patients (100%) became stone free.
RESULTS
CONCLUSIONS
2 patients had retroperitoneoscopy approach by 3 ports. The size of the stones was 3 and 4,2 cm, respectively. Surgical technique is described. Lithotripsy was continued until stone fragmentation was sufficient to permit safe and easy removal of all fragments. Any evidencce of urothelial trauma was noted. The number of shocks required for successful clearance was 25 y
The StoneBreaker appears to be an effective portable intracorporeal lithotripter that should plays an important role among endourological options for lithotripsy in children. Retroperitoneoscopy is an effective, minimally invasive, low-morbidity alternative to open nephrolitotomy for treatment of pelvicaliceal complex stones in the pediatric age.
MATERIAL AND METHODS We have treated two patients with unilateral pelvic struvita calculi using the StoneBreaker, a novel device, portable contact pneumatic intracorporeal lithotripter. The age at surgery was 2 and 4 years old. The patients presented with abdominal pain, nausea and vomiting and recurrent urinary tract infection due to Proteus and Pseudomona spp. Diagnosis was made by plain radiographs and renal