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Davis NF, Donaldson JF, Shepherd R, Neisius A, Petrik A, Seitz C, Thomas K, Lombardo R, Tzelves L, Somani B, Gambarro G, Ruhayel Y, Türk C, Skolarikos A. Treatment outcomes of bladder stones in children with intact bladders in developing countries: A systematic review of >1000 cases on behalf of the European Association of Urology Bladder Stones Guideline panel. J Pediatr Urol 2022; 18:132-140. [PMID: 35148953 DOI: 10.1016/j.jpurol.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Bladder stones (BS) are still endemic in children in developing nations and account for a high volume of paediatric urology workload in these areas. The aim of this systematic review is to comparatively assess the benefits and risks of minimally invasive and open surgical interventions for the treatment of bladder stones in children. METHODS This systematic review was conducted in accordance with Cochrane Guidance. Database searches (January 1970- March 2021) were screened, abstracted, and assessed for risk of bias for comparative randomised controlled trials (RCTs) and non-randomised studies (NRSs) with >10 patients per group. Open cystolithotomy (CL), transurethral cystolithotripsy (TUCL), percutaneous cystolithotripsy (PCCL), extracorporeal shock wave lithotripsy (ESWL) and laparoscopic cystolithotomy (LapCL) were evaluated. RESULTS In total, 3040 abstracts were screened, and 8 studies were included. There were 7 retrospective non-randomised studies (NRS's) and 1 quasi-RCT with 1034 eligible patients (CL: n=637, TUCL: n=196, PCCL: n=138, ESWL: n=63, LapCL n=0). Stone free rate (SFR) was given in 7 studies and measured 100%, 86.6%-100%, and 100% for CL, TUCL and PCCL respectively. CL was associated with a longer duration of inpatient stay than PCCL and TUCL (p<0.05). One NRS showed that SFR was significantly lower after 1 session with outpatient ESWL (47.6%) compared to TUCL (93.5%) and CL (100%) (p<0.01 and p<0.01 respectively). One RCT compared TUCL with laser versus TUCL with pneumatic lithotripsy and found that procedure duration was shorter with laser for stones <1.5cm (n=25, p=0.04). CONCLUSION In conclusion, CL, TUCL and PCCL have comparable SFRs but ESWL is less effective for treating stones in paediatric patients. CL has the longest duration of inpatient stay. Information gathered from this systematic review will enable paediatric urologists to comparatively assess the risks and benefits of all urological modalities when considering surgical intervention for bladder stones.
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Affiliation(s)
- N F Davis
- Beaumont and Connolly Hospitals, Department of Urology, Dublin, Ireland.
| | - J F Donaldson
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - R Shepherd
- European Association of Urology Guidelines Office, Arnhem, the Netherlands
| | - A Neisius
- Department of Urology, Hospital of the Brothers of Mercy Trier, Academic Teaching Hospital of the Johannes Gutenberg University, Department of Urology, Mainz, Germany
| | - A Petrik
- Department of Urology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - C Seitz
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - K Thomas
- Stone Unit, Guy's and St. Thomas' National Health Services Foundation Hospital, Department of Urology, London, UK
| | - R Lombardo
- Department of Urology, Ospedale Sant'Andrea 'Sapienza' University, Rome, Italy
| | - L Tzelves
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Medical School, Department of Urology, Athens, Greece
| | - B Somani
- Spire Southampton Hospital, Chalybeate Cl, Southampton, SO16 6UY, UK
| | - G Gambarro
- Head Division of Nephrology and Dialysis, University of Verona, Medicine, Verona, Italy
| | - Y Ruhayel
- Department of Urology, Skane University Hospital, Malmo, Sweden
| | - C Türk
- Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria
| | - A Skolarikos
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Medical School, Department of Urology, Athens, Greece
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Piskin MM, Özkent MS, Kılınç MT, Goger YE, Sönmez MG, Balasar M. Which Endoscopic Methods in Prepubertal Patients with 10-20 mm Bladder Stones: Transurethral Cystolithotripsy or Percutaneous Cystolithotripsy? J Endourol 2021; 35:1818-1823. [PMID: 34128398 DOI: 10.1089/end.2021.0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy and safety of transurethral cystolithotripsy(TUC) and percutaneous cystolithotripsy(PCC) in prepubertal patients with 10-20 mm bladder stones. MATERIALS AND METHODS The files of patients the age of 12 and under who were admitted our clinic for bladder stones from January 2007 to January 2021 were reviewed retrospectively. Inclusion criteria were patients who were 12 years of age and under with 10-20 mm bladder stones, and who underwent endoscopic surgery(TUC or PCC). None of the patients had prior bladder or stone surgery. The patients were divided into two groups(Group 1:PCC group, and Group 2:TUC group) and collected data(preoperative, intraoperative, and postoperative characteristics) were compared between the groups. RESULTS This present study was enrolled 51 patients(21 patients in Group 1 and 30 patients in Group 2).The mean ages of the groups were similar (Group 1:4.7±3.6; Group 2:4.6±3.2; p:0.936). The mean stone size was 15.8±3.5 in Group 1, and 12.1±2.4 mm in Group 2. It was higher in the PCC group than TUC group(p<0.001). The operative time was lower in Group 1 than Group 2(36.4±12.9 min vs. 42.7±16.3 min, respectively), but there was no statistically significance difference between the groups (p:0.117).We achieved SFR for all the patients in both groups. Complications were observed in four (7.7%) cases. One female patient was in Group 1 and three male patients were in Group 2. There was no difference for complication rates between the groups(p:0.634). CONCLUSIONS Endoscopic surgeries have almost become a routine method in the treatment of bladder stones. Despite larger stone size, PCC provides similar SFR compared with TUC along with a tendency of shorter operative time. However, the use of the TUC method in toddler males could increase the risk of postoperative urinary retention. Hence, stone size and patient age should be considered in the selection of a surgical approach.
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Affiliation(s)
- Mesut Mehmet Piskin
- Necmettin Erbakan University Meram Medical Faculty Hospital, 64222, Department of Urology, Konya, Turkey;
| | - Mehmet Serkan Özkent
- Konya Egitim ve Arastirma Hastanesi, 147027, Department of Urology, Hacışaban, Yeni Meram Cd. No:97,, Konya, Konya, Turkey, 42040.,Health Sciences University Meram Training And Research Hospital;
| | - Muzaffer Tansel Kılınç
- Necmettin Erbakan University Meram Medical Faculty Hospital, 64222, Urology, Necmettin Erbakan University Meram Medical Faculty Hospital Selcuklu/Konya, Konya, Turkey, 41100;
| | - Yunus Emre Goger
- Necmettin Erbakan University Meram Medical Faculty Hospital, 64222, Department of Urology, Konya, Turkey;
| | - Mehmet Giray Sönmez
- Necmettin Erbakan University Meram Medical Faculty Hospital, 64222, Department of Urology, Hekimoglu street, Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, 42090, Konya, Turkey, Konya, Turkey, 42090;
| | - Mehmet Balasar
- Necmettin Erbakan University Meram Medical Faculty Hospital, 64222, Department of Urology, Konya, Turkey;
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Jayasimha S, Marimuthu S, Rajendran G, Valson AT, Chandrasingh J, Kumar S. Extracorporeal shock wave lithotripsy in Indian children: Predictors of outcome and validation of pre-treatment nomograms. J Pediatr Urol 2021; 17:79.e1-79.e8. [PMID: 33279435 DOI: 10.1016/j.jpurol.2020.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/29/2020] [Accepted: 10/21/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although multiple variables have been shown to affect outcomes in pediatric lithotripsy (ESWL), there is no consensus on the same. Nomograms combine multiple variables and provide an objective prediction of outcomes. Two nomograms have been previously described and validated in two studies from the same geographical area. External validation in multiple settings is needed, as a nomogram's performance may vary with time, geographical area and clinical scenario. OBJECTIVES This study aimed to identify variables influencing pediatric ESWL outcomes, validate published nomograms and describe the clinical and metabolic profile of Indian children treated with ESWL. DESIGN This retrospective cohort study included all children who underwent ESWL from 2002 to 2019 at a single centre. ESWL was performed under general anaesthesia. Mid and lower ureteric calculi were treated in prone and the rest in supine position. 1500-2000 shocks were delivered at a voltage of 12-16 kV. Data pertaining to patient characteristics, metabolic evaluation, imaging, ESWL details and post-procedure outcomes were obtained from the hospital information system and these variables, along with Onal and Doğan scores, were correlated with stone clearance. Cut-offs for Onal and Doğan scores were determined using receiver operator characteristic (ROC) curve analysis and compared with area under the curve (AUC). Complications, ancillary procedures and metabolic abnormalities were recorded. RESULTS A total of 66 children (76 renal units) were included. Mean age was 5.5 years (Range 6 months-14 years) and median stone size, 12 mm (IQR 9, 15.25). Average treatment sessions were 1.8 ± 0.99. Median shocks in the stone-free group and those who failed treatment were 1750 (IQR 1500, 3000) and 3250 (IQR 1750, 4750) respectively. The remaining variables are depicted in Table 1. The stone free rate was 63.2%. Fragments <4 mm were seen in 19 (25%). Efficacy Quotient was 40. The AUC for Doğan nomogram (cut-off <199.5) was 0.761 while that for Onal nomogram (cut-off <2.5) was 0.762 and 0.771 after one and three shocks respectively. On multivariate analysis, age, multiple calculi, Onal and Doğan scores were predictive of clearance. Doğan score had higher specificity. Complications were seen in 16 (21%) and ancillary procedures needed in 7 (9.2%). Metabolic abnormalities were seen in 84.8%, the commonest being hyperoxaluria. Mixed stones were most frequent. CONCLUSIONS Lithotripsy in children is safe and effective. Older age, presence of multiple calculi, higher Onal and Doğan scores are predictive of treatment failure.
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Affiliation(s)
- Sudhindra Jayasimha
- Department of Urology, Christian Medical College, Vellore, 632004, Tamilnadu, India.
| | - S Marimuthu
- Department of Biostatistics, Christian Medical College, Vellore, 632004, Tamilnadu, India.
| | - Geetha Rajendran
- Department of Urology, Christian Medical College, Vellore, 632004, Tamilnadu, India.
| | - Anna T Valson
- Department of Nephrology, Christian Medical College, Vellore, 632004, Tamilnadu, India.
| | - J Chandrasingh
- Department of Urology, Christian Medical College, Vellore, 632004, Tamilnadu, India.
| | - Santosh Kumar
- Department of Urology, Christian Medical College, Vellore, 632004, Tamilnadu, India.
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Esposito C, Autorino G, Masieri L, Castagnetti M, Del Conte F, Coppola V, Cerulo M, Crocetto F, Escolino M. Minimally Invasive Management of Bladder Stones in Children. Front Pediatr 2020; 8:618756. [PMID: 33575232 PMCID: PMC7870782 DOI: 10.3389/fped.2020.618756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/15/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Bladder stones (BS) are rare in children. Minimally invasive surgery (MIS) seems to be nowadays the procedure of choice to treat pediatric patients with BS. This study aimed to analyze retrospectively our experience with percutaneous cystolithotomy, endourological treatment with Holmium laser and robotic cystolithotomy in children with BS. Methods: We retrospectively analyzed the data of 13 children (eight boys and five girls) with BS who were treated at our centers between July 2013 and July 2020. The patients received three different MIS procedures for stones removal: five underwent robotic cystolithotomy, five underwent endourological treatment and three received percutaneous cystolithotomy (PCCL). We preferentially adopted endourological approach for stones <10 mm, percutaneous approach between 2014 and 2016 and robotic approach since 2016 for larger stones. Results: Mean patients' age at the time of diagnosis was 13 years (range 5-18). Ten/13 patients (76.9%) had primary BS and 3/13 patients (23.1%) had secondary BS. Mean stone size was 18.8 mm (range 7-50). In all cases the stones were removed successfully. One Clavien II post-operative complication occurred following PCCL (33.3%). All the procedures were completed without conversions. Operative time ranged between 40 and 90 min (mean 66) with no significant difference between the three methods (p = 0.8). Indwelling bladder catheter duration was significantly longer after PCCL (mean 72 h) compared with robotic and endourological approaches (mean 15.6 h) (p = 0.001). Hospitalization was significantly longer after PCCL (mean 7.6 days) compared with the other two approaches (mean 4.7 days) (p = 0.001). The endourological approach was the most cost-effective method compared with the other two approaches (p = 0.001). Conclusions: Minimally invasive management of bladder stones in children was safe and effective. Endourological management was the most cost-effective method, allowing a shorter hospital stay compared with the other procedures but it was mainly indicated for smaller stones with a diameter < 10 mm. Based upon our preliminary results, robotic surgery seemed to be a feasible treatment option for BS larger than 15-20 mm. It allowed to remove the big stones without crushing them with a safe and easy closure of the bladder wall thanks to the easy suturing provided by the Robot technology.
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Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Giuseppe Autorino
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Lorenzo Masieri
- Pediatric Urology Unit, Meyer Children Hospital, Florence, Italy
| | | | - Fulvia Del Conte
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Vincenzo Coppola
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Mariapina Cerulo
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Felice Crocetto
- Urology Unit, Federico II University of Naples, Naples, Italy
| | - Maria Escolino
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
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