Endourology Methods in Pediatric Population for Kidney Stones Located in Lower Calyx: FlexURS vs. Micro PCNL
Adam Halinski1,2, Henri Steyaert3, Magdalena Wojciech4
1Department of Pediatric Urology, Private Medical Center "Klinika Wisniowa", Zielona Góra, Poland.
Insights
Flexible ureterorenoscopy and micro-PCNL are effective for pediatric kidney stones. Flexible ureterorenoscopy showed fewer complications and shorter hospital stays, making it a favorable option for lower calyx stones.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Management
- Minimally Invasive Surgery
Background:
- Kidney stone disease in children presents unique therapeutic challenges, often requiring specialized approaches.
- Lower calyx kidney stones are particularly difficult to treat, necessitating advanced surgical techniques.
- Established treatments include Extracorporeal Shock Wave Lithotripsy (ESWL), Retrograde IntraRenal Surgery (RIRS), and Percutaneous Nephro-Lithotripsy (PCNL).
Purpose of the Study:
- To compare the efficacy and safety of flexible ureterorenoscopy (fURS) and micro-Percutaneous Nephrolithotripsy (micro-PCNL) for treating lower calyx kidney stones in children.
- To evaluate stone-free rates, complication profiles, and hospital stay durations for both procedures.
- To assess the role of these endoscopic techniques in pediatric urology, considering alternatives like ESWL.
Main Methods:
- A retrospective analysis of 53 pediatric patients treated for lower calyx kidney stones.
- Thirty-eight patients underwent flexible ureterorenoscopy (fURS), and 15 underwent micro-PCNL.
- Data collected included stone size, stone-free rate (SFR), complication incidence, and inpatient duration.
Main Results:
- Both fURS and micro-PCNL demonstrated high stone-free rates (84.21% for fURS, 86.7% for micro-PCNL).
- Flexible ureterorenoscopy was associated with a lower risk of complications and a shorter mean hospital stay (3 days).
- Average stone sizes were comparable: 12.2 mm for fURS and 13.5 mm for micro-PCNL.
Conclusions:
- Flexible ureterorenoscopy and micro-PCNL are comparably effective for pediatric lower calyx stones of all sizes.
- Flexible ureterorenoscopy offers advantages in terms of reduced complications and shorter hospitalizations.
- Further prospective, randomized, multicenter trials are needed to definitively establish optimal treatment strategies, considering the established role of ESWL in pediatric populations.
Abstract:
Kidney stone disease in children is always a therapeutic challenge. It is a multifactorial condition and it should be approached, diagnosed and treated as such. One of the biggest challenges is kidney stones located in the lower renal calyx. There are currently three main surgical techniques to treat this condition: ESWL-Extracorporeal Shock Wave Lithotripsy, RIRS-Retrograde IntraRenal Surgery, and PCNL-PerCutaneous Nephro-Lithotripsy. In pediatric population, the most frequently used method is ESWL, and in the event of failure, endoscopic procedures are the second-best choice. In this article, a sample of 53 children admitted to a tertiary medical center was examined. Thirty-eight of those children underwent flexible URS, while the remaining 15-micro PCNL. The average size of the deposit in the former group was 12.2 mm, against 13.5 mm in the latter. The full Stone Free Rate (SFR) was achieved in RIRS at 84.21 and 86.7% in percutaneous nephrolithotripsy. Flexible ureterorenoscopy and MicroPERC are two comparably effective methods for treating lower calyx stones of any size. However, according to our data, flexible ureterorenoscopy carries a lower risk of complications and inpatient care (with the mean of 3 days). The learning curve for these procedures in pediatric urology is long and relies on a limited number of patients. The number of pediatric patients qualifying for these procedures is restricted also due to the high efficacy of extracorporeal shock wave lithotripsy in pediatric population. Radiation exposure is an important factor in every endoscopy procedure and should never exceed the limits set in the ALARA protocol. ESWL remains to this day the treatment of choice for stone disease in children and can be performed under ultrasound control. For many parents, it is a first-choice treatment preference for their child due to its greater apparent safety, although data on this remains insufficient. Prospective, randomized, multicenter trials are definitely needed.
Related Concept Videos
01:25Urinary Tract Calculi VI: Surgical Management
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography
01:30Urinary Tract Calculi III: Medical Management
01:28Urologic Endoscopic Procedure: Cystoscopic Examination
01:28Urinary Tract Calculi I: Introduction
01:28Urinary Tract Calculi V: Nursing Management