Minimal access surgery in the management of pediatric urolithiasis
Ana Catarina Fragoso1, Henry Steyaert2, Pierre Arnaud2
1Department of Pediatric Surgery, Faculty of Medicine of Porto, Hospital S. Joa˜o, 4200-319 Porto, Portugal.
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 to open surgery.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Urolithiasis Management
Background:
- Pediatric urolithiasis often requires open surgery, unlike adult cases.
- Minimal access surgery (MAS) techniques can replicate open surgical procedures.
- MAS offers a potential alternative for managing urinary tract stones in children.
Purpose of the Study:
- To evaluate the feasibility and outcomes of MAS for pediatric urolithiasis.
- To assess MAS as a treatment option for children with urinary calculi.
- To determine the safety and efficacy of MAS in pediatric stone disease.
Main Methods:
- Retrospective review of pediatric urolithiasis patients treated with MAS (1994-2007).
- Inclusion criteria: failed or contraindicated lithotripsy/endourology.
- Evaluation of patient demographics, 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 stone removal achieved in 82% of procedures; 2 perioperative complications occurred.
Conclusions:
- MAS is an effective and safe treatment for pediatric urolithiasis.
- It is particularly suitable for children unsuitable for other minimally invasive techniques.
- MAS provides a viable surgical option for complex pediatric stone cases.
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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