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Minimal access surgery in the management of pediatric urolithiasis
Ana Catarina Fragoso1, Jean-Stéphane Valla, Henry Steyaert
1Department of Pediatric Surgery, Faculty of Medicine of Porto, Hospital S João, Porto, Portugal. catarina.fragoso@gmail.com
Insights
Minimal access surgery (MAS) is effective for pediatric urolithiasis when other methods fail. This approach safely removes urinary calculi in children, offering a viable alternative for complex cases.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Urolithiasis Management
Background:
- Pediatric urolithiasis often requires open surgery, unlike in adults.
- Minimal access surgery (MAS) offers a potential alternative to open procedures.
- Investigating MAS feasibility and outcomes in pediatric urinary calculi is warranted.
Purpose of the Study:
- To assess the feasibility and outcomes of MAS for pediatric urolithiasis.
- To evaluate MAS in children with contraindications or failures of other treatments.
- To determine the safety and efficacy of MAS in managing pediatric urinary stones.
Main Methods:
- Retrospective review of pediatric urolithiasis patients treated with MAS (1994-2007).
- Inclusion criteria: failure or contraindication of lithotripsy/endourology.
- Evaluation of demographic data, stone characteristics, predisposing factors, and surgical outcomes.
Main Results:
- 17 MAS procedures performed on 15 children (median age 108 months).
- 11 children had urogenital malformations; 3 had metabolic abnormalities.
- Complete calculi removal in 82% of procedures, with 2 perioperative complications.
Conclusions:
- MAS is an effective and safe treatment for pediatric urolithiasis in selected patients.
- Individualized MAS techniques can manage most pediatric urinary stone cases.
- MAS may be considered as a first-line therapy in specific pediatric urolithiasis cases.
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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