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Satjakoesoemah AI, Alfarissi F, Wahyudi I, Rodjani A, Rasyid N. Factors related to the success rate of pediatric extracorporeal shock wave lithotripsy (ESWL) in Cipto Mangunkusumo Hospital: an 8-year single-center experience. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00187-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
ESWL is still considered as the first favorable therapeutic option for urinary stone disease with acceptable effectivity. However, factors associated with favorable outcome have not been widely studied in pediatrics due to the small number of urinary stone prevalence. The aim of this study is to evaluate the factors associated with the success rate of pediatric ESWL in our center according to immediate stone-free rate and 3-month stone-free rates.
Methods
This is a retrospective cohort study of children less than 18 years who had ESWL for urolithiasis from January 2008 until August 2015. Patient’s characteristics including age, gender, BMI, stone location, stone length, stone burden, stone opacity, and number of ESWL sessions were gathered from the medical record. Nutritional status was determined according to the Centers for Disease Control and Prevention BMI curve. The outcome of this study was the factors related to the success rate in pediatric ESWL.
Results
Extracorporeal shock wave lithotripsy was done for 36 patients and 39 renal units (RUs) with mean age of 13.7 ± 4.3 years old, height of 1480 ± 16.0 cm, and BMI of 20.0 ± 3. Of 36 patients included, 39 renoureteral units (RUs) and 46 ESWL sessions were recorded. The mean overall treatment was 1.2 ± 0.5 sessions with mean stone length of 11.1 ± 6.3 mm and stone burden of 116.6 ± 130.3 mm2. Within 3 months of follow-up, we recorded that the overall 3-month success rate was 100%, while the overall 3-month stone-free rate was 66.7%. Stone length (p < 0.001 and p < 0.001), stone perpendicular length (p < 0.001 and p < 0.001), and stone burden (p < 0.001 and p = 0.001) were found to be significantly associated with immediate success and 3-month stone-free status, respectively.
Conclusions
ESWL is an effective and safe modality to treat pediatric urolithiasis cases. Stone length, stone perpendicular length, and stone burden were found to be associated with immediate success and 3-month stone-free status after pediatric ESWL treatment.
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Fragoso AC, Steyaert H, Arnaud P, Esposito C, Estevao-Costa J, Valla JS. Minimal access surgery in the management of pediatric urolithiasis. Transl Pediatr 2016; 5:262-265. [PMID: 27867850 PMCID: PMC5107375 DOI: 10.21037/tp.2016.09.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In contrast to adult patients, a relatively large number of open surgical procedures are still needed in the treatment of urolithiasis in children. Since almost all open surgical techniques may be reproduced by minimal access surgery (MAS), there is a rationale to apply the latter in the management of pediatric urolithiasis. Our study aimed to assess the feasibility and outcome of MAS in the treatment of pediatric urinary calculi. METHODS The charts of patients with urolithiasis submitted to MAS between 1994 and 2007 were retrospectively reviewed. The inclusion criteria were contraindication for and failure of lithotripsy or endourology techniques. Demographic data, lithiasis characterization (location, dimension, composition), predisposing factors (anatomic or metabolic) and surgical approach (technique and outcome) were evaluated. RESULTS Fifteen consecutive patients (eight girls, seven boys) with a median age of 108 months (range: 10-297 months) were elected for MAS. Eleven (73%) children had associated urogenital malformations and three (20%) presented metabolic abnormalities. A total of 17 procedures were performed laparoscopically: three nephrolithotomy (one transperitoneal, two by retroperitoneoscopy), four pyelolithotomies (retro), three ureterolithotomy (trans) and seven cystolithotomies (suprapubic approach). Five patients underwent concomitant correction of urological anomalies (three calyceal diverticula, one obstructive megaureter, one ureteropelvic junction obstruction). Complete removal of calculi was accomplished in 14 (82%) procedures. There were two perioperative complications (one intraperitoneal vesical perforation and one perivesical urinoma). At a median follow up of 4 years (range, 1 month to 11 years), four patients have developed recurrence. CONCLUSIONS MAS is an effective and safe approach for urolithiasis in children who are not candidates for minimally invasive modalities.
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Affiliation(s)
- Ana Catarina Fragoso
- Department of Pediatric Surgery, Faculty of Medicine of Porto, Hospital S. Joa˜o, 4200-319 Porto, Portugal
| | - Henry Steyaert
- Department of Pediatric Surgery, Hospital Lenval, Nice, France
| | - Pierre Arnaud
- Department of Pediatric Surgery, Hospital Lenval, Nice, France
| | - Ciro Esposito
- Department of Pediatrics, Pediatric Surgery, ''Frederico II'' University of Naples, School of Medicine, Naples, Italy
| | - Jose Estevao-Costa
- Department of Pediatric Surgery, Faculty of Medicine of Porto, Hospital S. Joa˜o, 4200-319 Porto, Portugal
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Tejwani R, Wang HHS, Wolf S, Wiener JS, Routh JC. Outcomes of Shock Wave Lithotripsy and Ureteroscopy for Treatment of Pediatric Urolithiasis. J Urol 2016; 196:196-201. [PMID: 26997313 DOI: 10.1016/j.juro.2016.02.2975] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Shock wave lithotripsy has been commonly used to treat children with renal and ureteral calculi but recently ureteroscopy has been used more frequently. We examined postoperative outcomes from these 2 modalities in children. MATERIALS AND METHODS We reviewed linked inpatient, ambulatory surgery and emergency department data from 2007 to 2010 for 5 states to identify pediatric admissions for renal/ureteral calculi treated with shock wave lithotripsy or ureteroscopy. Unplanned readmissions, additional procedures and emergency room visits were extracted. Multivariate logistic regression using generalized estimating equations to adjust for hospital level clustering was performed. RESULTS We identified 2,281 admissions (1,087 for shock wave lithotripsy and 1,194 for ureteroscopy). Ages of patients undergoing ureteroscopy and those undergoing shock wave lithotripsy were similar (median 17.0 years for both cohorts, p = 0.001) but patients were more likely to be female (63.4% vs 54.7%, p <0.0001), to be privately insured (69.8% vs 62.2%, p <0.0005) and to have a ureteral stone (81.0% vs 34.8%, p <0.0001). Patients undergoing ureteroscopy demonstrated a lower rate of additional stone related procedures within 12 months (13.6% vs 18.8%, p <0.0007) but a higher rate of readmissions (10.8% vs 6.3%, p <0.0002) and emergency room visits (7.9% vs 4.9%, p <0.0036) within 30 days postoperatively. On multivariable analysis patients undergoing ureteroscopy were nearly twice as likely to visit an emergency room within 30 days of the procedure (OR 1.97, p <0.001) and to be readmitted to inpatient services (OR 1.71, p <0.01). CONCLUSIONS Ureteroscopy is now used more commonly than shock wave lithotripsy for initial pediatric stone intervention. Although repeat treatment rates did not differ between procedures, ureteroscopy patients were more likely to be seen at an emergency room or hospitalized within 30 days of the initial procedure.
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Affiliation(s)
- Rohit Tejwani
- Duke University School of Medicine, Durham, North Carolina
| | - Hsin-Hsiao S Wang
- Duke University School of Medicine, Durham, North Carolina; Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Steven Wolf
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - John S Wiener
- Duke University School of Medicine, Durham, North Carolina; Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jonathan C Routh
- Duke University School of Medicine, Durham, North Carolina; Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
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Dede O, Sancaktutar AA, Baş O, Dağgüllu M, Utangaç M, Penbegul N, Soylemez H, Hatipoglu NK, Bodakci MN, Bozkurt Y, Atar M, Dede G. Micro-percutaneous nephrolithotomy in infants: a single-center experience. Urolithiasis 2015. [PMID: 26209010 DOI: 10.1007/s00240-015-0807-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This study aimed to investigate the effectiveness and reliability of micro-percutaneous nephrolithotomy (micro-PNL) for the management of kidney stones in pediatric patients. This retrospective study included 24 infants that underwent micro-PNL for renal stones between March 2012 and April 2015. The inclusion criteria included: age younger than 2 years, stone size <20 mm, absence of urinary tract malformations and active infection, and no coagulopathy. Stone-free rates were assessed one month postoperatively by ultrasonography (USG) and kidneys, ureters, bladder (KUB) radiography. Complications were classified according to the Clavien classification system. The mean age of the patients was 15.8 ± 7.8 months (range, 8-23) and the mean stone size was 13.5 ± 3.84 mm. Intra-renal access was achieved using USG in 11 patients and KUB fluoroscopy in 13 patients. The operation time and fluoroscopic screening time were 53.7 ± 10.35 and 1.4 ± 0.9 min, respectively. The mean hospital stay was 2.5 ± 0.8 days, and the mean drop in the hemoglobin level was 0.51 ± 0.34 g/dL. Bleeding requiring blood transfusion was not observed. A ureteral J stent was implanted perioperatively in four patients because of stone burden. Four patients complained of postoperative renal colic (Clavien grade 1) and postoperative fever was observed in two patients. Definitive success rates were as follows: the stone-free rate was 83.3% (n = 20) and residual fragments were observed in four patients.
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Affiliation(s)
- Onur Dede
- Department of Urology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey.
| | | | - Okan Baş
- Department of Urology, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Mansur Dağgüllu
- Department of Urology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Mazhar Utangaç
- Department of Urology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Necmettin Penbegul
- Department of Urology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Haluk Soylemez
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Mehmet Nuri Bodakci
- Department of Urology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Yaşar Bozkurt
- Department of Urology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Murat Atar
- Department of Urology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Gülay Dede
- Department of Clinical Microbiology and Infectious Diseases, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
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Azili MN, Ozturk F, Inozu M, Çayci FŞ, Acar B, Ozmert S, Tiryaki T. Management of stone disease in infants. Urolithiasis 2015; 43:513-9. [PMID: 26036325 DOI: 10.1007/s00240-015-0788-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/19/2015] [Indexed: 11/29/2022]
Abstract
Evaluating and treating renal stone disease in infants are technically challenging. In this study, we evaluated the surgical treatment of renal stones in children under 1 year of age. We retrospectively reviewed the records of patients under 1 year old who were treated with ESWL, endourological or open surgical procedures for renal stone disease between January, 2009 and December, 2012. The patients' age, gender, stone size, stone location and number, complications, stone-free status, and postoperative complications were recorded. 19 of 121 infants with a mean age of 10.2 ± 3.07 months were treated with surgical procedures. Six (75%) of eight cystinuria patients required a surgical intervention. Retrograde endoscopic management was performed in thirteen patients (63.4%) as an initial surgical approach. There were three major (15.7%) complications. The rate of open surgical procedures was 31.6% (6 of 19 infants). The cutoff value of stone size for open surgery was 10 mm. There was a significant relationship between the conversion to open procedures and stone size, stone location, and symptom presentation especially the presence of obstruction (p < 0.05). After repeated treatments, the stone clearance rate of RIRS reached 84.6%. Retrograde intrarenal surgery is an effective and safe treatment method for renal stones in infants and can be used as a first-line therapy in most patients under 1 year old. This is especially important if an associated ureteral stone or lower pole stone that requires treatment is present and for patients with cystinuria, which does not respond favorably to ESWL.
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Affiliation(s)
- Mujdem Nur Azili
- Department of Pediatric Surgery, Ankara Child Diseases Hematology and Oncology Education and Research Hospital, No:10 Diskapi, 06110, Ankara, Turkey.
| | - Fatma Ozturk
- Department of Pediatric Surgery, Ankara Child Diseases Hematology and Oncology Education and Research Hospital, No:10 Diskapi, 06110, Ankara, Turkey
| | - Mihriban Inozu
- Department of Pediatric Nephrology, Ankara Child Diseases Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Fatma Şemsa Çayci
- Department of Pediatric Nephrology, Ankara Child Diseases Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Banu Acar
- Department of Pediatric Nephrology, Ankara Child Diseases Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Sengul Ozmert
- Department of Anesthesiology, Ankara Child Diseases Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Tugrul Tiryaki
- Department of Pediatric Urology, Ankara Child Diseases Hematology and Oncology Education and Research Hospital, Ankara, Turkey
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Adanur S, Ziypak T, Yılmaz AH, Kocakgol H, Aksoy M, Yapanoglu T, Polat O, Aksoy Y. Extracorporeal shockwave lithotripsy under sedoanalgesia for treatment of kidney stones in infants: a single-center experience with 102 cases. Int Urol Nephrol 2014; 46:2095-101. [PMID: 25080207 DOI: 10.1007/s11255-014-0788-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/09/2014] [Indexed: 10/25/2022]
Abstract
OBJECT We present the efficacy of shockwave lithotripsy (SWL) therapy administered with sedoanalgesia in infants with kidney stones. MATERIALS AND METHODS We enrolled 102 patients aged 5-24 months who had kidney stones and received SWL therapy under sedoanalgesia using a Siemens Lithostar Modularis device. Patient and stone characteristics, therapy parameters, pain score, complications, discharge time, and follow-ups were registered and evaluated. Pain score was assessed using a Neonatal Infant Pain Score (NIPS). Postanesthetic discharge scoring system (PADSS) was used for the assessments of postprocedural discharge procedure. RESULTS Mean age of the patients was 17.2 ± 6.3 months (5-24 months). Mean stone size was 7.9 ± 3.3 mm (5-23 mm). The most common concomitant metabolic disorders were hypercalciuria and hypocitraturia. The stone-free rates of the infants were 70.6, 87.3, and 99.1 % after the first, second, and third sessions of SWL therapy, respectively. The mean NIPS scores procedure during, and at 1 h after SWL procedure were determined as 0.24 ± 0.45 and 0.34 ± 0.47, respectively. There was no statistically significant difference between two pain score values (P = 0.114). The mean discharge time of patients after the SWL procedure were 108.6 ± 27.9 min. Forty-two patients (41.1 %) were followed up. The follow-up period varied between 8 and 48 months (mean 19.5 months); none of those patients showed evidence of diabetes mellitus, hypertension, or renal function impairment. CONCLUSIONS SWL therapy under sedoanalgesia is a safe and efficient treatment modality that can be administered with low complication rates and high stone-free rates in the treatment of renal stones in infants.
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Affiliation(s)
- Senol Adanur
- Department of Urology, School of Medicine, Ataturk University, 25240, Erzurum, Turkey,
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Jeong US, Lee S, Kang J, Han DH, Park KH, Baek M. Factors affecting the outcome of extracorporeal shock wave lithotripsy for unilateral urinary stones in children: a 17-year single-institute experience. Korean J Urol 2013; 54:460-6. [PMID: 23878689 PMCID: PMC3715710 DOI: 10.4111/kju.2013.54.7.460] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/30/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Extracorporeal shock wave lithotripsy (ESWL) is a first-line treatment for pediatric urinary stone disease. We aimed to determine the factors affecting the outcome of ESWL for unilateral urinary stones in children. MATERIALS AND METHODS A total of 81 pediatric patients aged 0 to 16 years with urinary stones treated by ESWL from January 1995 through May 2012 were retrospectively reviewed. All patients were required to have unilateral urinary stone disease. Children who underwent other surgical procedures before ESWL were excluded. Outcomes evaluated after ESWL were the stone-free rate at 3 months after ESWL, success within a single session, and success within three sessions. Factors affecting the success within three sessions were also analyzed. RESULTS The final analysis was for 42 boys and 22 girls (mean age, 9.2±5.2 years). Of these 64 patients, 58 (90.6%) were treated by ESWL without other surgical procedures and 54 (84.4%) were successfully treated within three ESWL sessions. In the multivariate analysis, multiplicity (odds ratio [OR], 0.080; 95% confidence interval [CI], 0.012 to 0.534; p=0.009) and large stone size (>10 mm; OR, 0.112; 95% CI, 0.018 to 0.707; p=0.020) were significant factors that decreased the success rate within three ESWL sessions. CONCLUSIONS Most of the pediatric urinary stone patients in our study (90.6%) were successfully treated by ESWL alone without additional procedures. If a child has a large urinary stone (>10 mm) or multiplicity, clinicians should consider that several ESWL sessions might be needed for successful stone fragmentation.
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Affiliation(s)
- U-Seok Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Agrawal V, Bajaj J, Acharya H, Chanchalani R, Raina VK, Sharma D. Laparoscopic management of pediatric renal and ureteric stones. J Pediatr Urol 2013; 9:230-3. [PMID: 22498008 DOI: 10.1016/j.jpurol.2012.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess the feasibility of laparoscopy in the treatment of pediatric urolithiasis, we report our experience with the transperitoneal laparoscopic removal of stones. METHOD Renal pelvic stones of size ≥1 cm on ultrasound were included for laparoscopic pyelolithotomy while smaller stones were managed with shock-wave lithotripsy monotherapy. Intrarenal stones, calyceal stones, complete staghorn stones, multiple stones and kidneys with intrarenal pelvis were excluded. Ureteric stones included for laparoscopic ureterolithotomy were of size ≥1 cm in the upper, mid or lower ureter, and smaller stones not responding to non-operative treatment. RESULTS A total of 22 procedures were performed: 12 pyelolithotomies, and 8 lower and 2 upper ureterolithotomies. Complete removal of calculi was accomplished in 21 (95.45%) procedures. Complications associated with laparoscopic lithotomy included urinoma (4.54%), failure (4.54%) and omental prolapse (4.54%). CONCLUSION Laparoscopic lithotomy is safe and feasible in pediatric urolithiasis with pyelic and ureteric stones, with minimal complications and failure rate.
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Affiliation(s)
- Vikesh Agrawal
- Department of Surgery, NSCB Government Medical College, Jabalpur 482003, India.
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Jia J, Shen X, Wang L, Zhang T, Xu M, Fang X, Xu G, Qian C, Wu Y, Geng H. Extracorporeal shock wave lithotripsy is effective in treating single melamine induced urolithiasis in infants and young children. J Urol 2012. [PMID: 23201375 DOI: 10.1016/j.juro.2012.11.109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE We evaluated the safety and efficacy of extracorporeal shock wave lithotripsy in the treatment of single melamine induced urolithiasis in infants and young children. MATERIALS AND METHODS A total of 189 infants and young children with single melamine induced urolithiasis were referred to our center for treatment with extracorporeal shock wave lithotripsy between March 2009 and July 2010. Location of the calculus was proximal ureteral in 17 patients, mid ureteral in 5, distal ureteral in 26 and kidney in 141. Stone size ranged from 3.8 to 25 mm (mean ± SD 9.79 ± 3.83). RESULTS All patients underwent extracorporeal shock wave lithotripsy using the same device with an energy ranging from 8 to 12 kV. Stone-free rate was 97.88%, clinically insignificant residual fragment rate was 1.59% and repeat treatment rate was 2.65%. A total of 180 patients (95.24%) required only 1 lithotripsy session and 5 (2.65%) required 2 sessions. Mean ± SD number of shock waves delivered per session was 580.36 ± 190.69 (range 65 to 950). Extracorporeal shock wave lithotripsy failed to fragment stones in only 1 infant, who had a proximal ureteral stone. A total of 181 specimens were collected and analyzed by infrared spectrum, with results demonstrating that the main composition was uric acid and melamine. All patients were followed for a mean of 28 months (range 20 to 36). No severe complication, such as renal subcapsular hemorrhage, hypertension, kidney rupture or lung injury, was observed. CONCLUSIONS Extracorporeal shock wave lithotripsy with low energy can effectively disintegrate melamine induced calculi. This approach has become our preferred method for treating single melamine induced urolithiasis in infants and young children.
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Affiliation(s)
- Jianye Jia
- Department of Pediatric Urology, Xinhua Hospital, Shanghai Jiao tong University School of Medicine and Children's Urolithiasis Treatment Center of Chinese Ministry of Health, Shanghai, China
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Yucel S, Akin Y, Danisman A, Guntekin E. Complications and Associated Factors of Pediatric Extracorporeal Shock Wave Lithotripsy. J Urol 2012; 187:1812-6. [DOI: 10.1016/j.juro.2011.12.092] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Indexed: 10/28/2022]
Affiliation(s)
- Selcuk Yucel
- Department of Urology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Yigit Akin
- Department of Urology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ahmet Danisman
- Department of Urology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Erol Guntekin
- Department of Urology, Akdeniz University School of Medicine, Antalya, Turkey
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Shock Wave Lithotripsy vs Ureteroscopy: Variation in Surgical Management of Kidney Stones at Freestanding Children's Hospitals. J Urol 2012; 187:1402-7. [DOI: 10.1016/j.juro.2011.12.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Indexed: 11/18/2022]
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Mohamad Al-Ali B, Pummer K. Large stone clearance in 2-year-old child with staghorn and calyceal stones using SWL monotherapy. Cent European J Urol 2012; 65:28-9. [PMID: 24578919 PMCID: PMC3921768 DOI: 10.5173/ceju.2012.01.art8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 12/27/2011] [Accepted: 01/17/2012] [Indexed: 12/26/2022] Open
Abstract
Treatment of pediatric urolithiasis requires a thorough metabolic and urological evaluation on an individual basis. The objective of our case report was to determine the efficiency and the role of shockwave lithotripsy (SWL) in the treatment of pediatric urolithiasis. In this case report we reported our own experience in the management of staghorn and calyceal stones in both kidneys with SWL. In our case, clearance of multiple staghorn stones and a calyceal stone was obtained without any complications after 7 sessions of SWL over 2 months.
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Affiliation(s)
| | - Karl Pummer
- Department of Urology, Medical University of Graz, Graz, Austria
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Rizvi SA, Sultan S, Ijaz H, Mirza ZN, Ahmed B, Saulat S, Umar SA, Naqvi SA. Open surgical management of pediatric urolithiasis: A developing country perspective. Indian J Urol 2011; 26:573-6. [PMID: 21369393 PMCID: PMC3034069 DOI: 10.4103/0970-1591.74464] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objectives To describe decision factors and outcome of open surgical procedures in the management of children with stone. Materials and Methods Between January 2004 and December 2008, 3969 surgical procedures were performed in 3053 children with stone disease. Procedures employed included minimally invasive techniques shockwave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS), perurethral cystolithotripsy (PUCL), percutaneous cystolithotripsy (PCCL), and open surgery. From sociomedical records demographics, clinical history, operative procedures, complications, and outcome were recorded for all patients. Results Of 3969 surgeries, 2794 (70%) were minimally invasive surgery (MIS) techniques to include SWL 19%, PCNL 16%, URS 18.9%, and PUCL+PCCL 16% and 1175 (30%) were open surgeries. The main factors necessitating open surgery were large stone burden 37%, anatomical abnormalities 16%, stones with renal failure 34%, gross hydronephrosis with thin cortex 58%, urinary tract infection (UTI) 25%, and failed MIS 18%. Nearly 50% of the surgeries were necessitated by economic constraints and long distance from center where one-time treatment was preferred by the patient. Stone-free rates by open surgeries were pyelolithotomy 91%, ureterolithotomy 100%, and cystolithotomy 100% with complication rate of upto 3%. Conclusions In developing countries, large stone burden, neglected stones with renal failure, paucity of urological facilities, residence of poor patients away from tertiary centers necessitate open surgical procedures as the therapy of choice in about 1/3rd of the patients. Open surgery provides comparable success rates to MIS although the burden and nature of disease is more complex. The scope of open surgery will remain much wide for a large population for considered time in developing countries.
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Affiliation(s)
- Syed A Rizvi
- Department of Urology, Sindh Institution of Urology and Transplantation, Karachi, Pakistan
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Stamatiou KN, Heretis I, Takos D, Papadimitriou V, Sofras F. Extracorporeal shock wave lithotripsy in the treatment of pediatric urolithiasis: a single institution experience. Int Braz J Urol 2010; 36:724-30; discussion 731. [DOI: 10.1590/s1677-55382010000600011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2010] [Indexed: 11/22/2022] Open
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McAdams S, Kim N, Ravish IR, Monga M, Ugarte R, Nerli R, Shukla AR. Stone Size is Only Independent Predictor of Shock Wave Lithotripsy Success in Children: A Community Experience. J Urol 2010; 184:659-64. [DOI: 10.1016/j.juro.2010.03.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Sean McAdams
- Department of Urologic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Nicholas Kim
- Department of Urologic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Indupur R. Ravish
- Department of Urology, KLES Kidney Foundation, Nehru Nagar, Belgaum, India
| | - Manoj Monga
- Department of Urologic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | - Rajendra Nerli
- Department of Urology, KLES Kidney Foundation, Nehru Nagar, Belgaum, India
| | - Aseem R. Shukla
- Department of Urologic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
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Abstract
PURPOSE OF REVIEW We review the recent literature on pediatric urolithiasis and present up-to-date findings on epidemiology, diagnosis, and medical and surgical management. RECENT FINDINGS There are surprisingly few reliable data on pediatric urolithiasis incidence, but widespread anecdotal and single-center reports suggest that more children with stones are being seen. The contamination of Chinese infant formula with melamine caused urolithiasis and other renal problems in hundreds of thousands of infants in the region, underlining the role of environmental factors in urolithiasis. Efforts continue to determine normal metabolic parameters in children, but have been hampered by variations among regions, races, and ethnicities. The Bonn Risk Index may prove to be a useful tool for assessing risk of urolithiasis in children. Children with recurrent urolithiasis are more likely to have detectable metabolic abnormalities. Surgical approaches to urolithiasis in children continue to evolve, with robotic-assisted laparoscopy being perhaps the most significant new technique. Finally, clinicians and radiologists must be aware of the potential for dextranomer/hyaluronic acid (Deflux) implants to mimic distal ureteral stones on computed tomography (CT) scan. SUMMARY Pediatric urolithiasis is an expanding field, due in part to the apparent increase in cases. Research continues, seeking to refine the appropriate diagnostic and therapeutic approaches in these unfortunate children.
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Minimal access surgery in the management of pediatric urolithiasis. J Pediatr Urol 2009; 5:42-6. [PMID: 18805739 DOI: 10.1016/j.jpurol.2008.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Accepted: 07/28/2008] [Indexed: 11/23/2022]
Abstract
PURPOSE In contrast to adult patients, a relatively large number of open surgical procedures are still needed in the treatment of urolithiasis in children. Since almost all open surgical techniques may be reproduced by minimal access surgery (MAS), there is a rationale to apply the latter in the management of pediatric urolithiasis. Our study aimed to assess the feasibility and outcome of MAS in the treatment of pediatric urinary calculi. MATERIALS AND METHODS The charts of patients with urolithiasis submitted to MAS between 1994 and 2007 were retrospectively reviewed. The inclusion criteria were contraindication for and failure of lithotripsy or endourology techniques. Demographic data, lithiasis characterization (location, dimension, composition), predisposing factors (anatomic or metabolic) and surgical approach (technique and outcome) were evaluated. RESULTS Fifteen consecutive patients (eight girls, seven boys) with a median age of 108 months (range: 10-297) were elected for MAS. Eleven (73%) children had associated urogenital malformations and three (20%) presented metabolic abnormalities. A total of 17 procedures were performed laparoscopically: three nephrolithotomies (one transperitoneal, two by retroperitoneoscopy), four pyelolithotomies (retro), three ureterolithotomies (trans) and seven cystolithotomies (suprapubic approach). Five patients underwent concomitant correction of urological anomalies (three calyceal diverticula, one obstructive megaureter, one ureteropelvic junction obstruction). Complete removal of calculi was accomplished in 14 (82%) procedures. There were two perioperative complications (one intraperitoneal vesical perforation and one perivesical urinoma). At a median follow up of 4 years (range: 1 month to 11 years), four patients have developed recurrence. CONCLUSIONS Minimal access surgery is an effective and safe approach for urolithiasis in children who are not candidates for minimally invasive modalities. Individualized application of different techniques may solve virtually all cases. In selected cases, the role of MAS as first-choice therapy deserves consideration.
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