Presentation Authors: Salvatore Micali*, Luigi bevilacqua, Modena, Italy, Ahmed Elsherbiny, Tanta, Egypt, Corradino Di Pietro, Silvia Ciarlariello, Viviana Durante, Modena, Italy, Ahmed Eissa, Tanta, Egypt, Stefano Puliatti, Nancy Ferrari, Alessandro Mofferdin, Maria Chiara Sighinolfi, Giampaolo Bianchi, Bernardo Maria Rocco, Modena, Italy
Introduction: There is a growing interest in pediatric urolithiasis because of the increasing incidence over the last two decads especially in western population and developing countries. Pediatric urolithiasis can cause significant renal morbidity, or even renal failure. On contrary to adults, the symptomatology in children could be indefinite and vague. There is an abundance of literature on adult urolithiasis, but series from the pediatric population are still poor. We herein review our experience for the treatment of urolithiasis in pediatric patients.
Methods: We retrospectively collected data from the medical records of all children treated for urolithiasis at our centre starting from January 2005 to June 2018. We reviewed and statistically analysed demographic and preoperative patients&[prime] characteristics (sex, age, comorbidities, preoperative renal function), stone (stone size, location, and Hounsfield units), intraoperative (operative time, complications, and hemoglobin drop) and follow-up data (stone-free rate [SFR]). SFR was defined as the absence of any stone fragment more than or equal to 2 mm. Any patient with missing data was excluded from the analysis. The treatment modalities performed were extracorporeal shock wave lithotripsy (ESWL), ureteroscopy and percutaneous nephrolithotomy (PCNL)
Results: From January 2005 to June 2018 we treated 73 children (31 PCNL,21 ureteroscopy, and 21 ESWL). The mean age was 10.2 and male:female ratio was 3:1. Mean stone size was 11 mm (5-20 mm), 23 mm (15-35 mm), and 9 mm (5-12 mm) for ureteroscopy, PCNL, and ESWL, respectively.Mean operative time was 192 minutes and 89.5 minutes for PCNL and ureteroscopy, respectively. Ureteroscopies were performed using Stortz XFlexC Ureteroscope (8 FR); the initial pediatric series of PCNL was carried out with 26 Fr Nephroscope, and then changed to Minimally Invasive PCNL instruments (MIP) 9.5 and 15 Fr. Global SFR after the primary procedure was 88%; the remaining cases underwent a second-look endourological approach. Clavien Dindo II complications (fever in all cases, responsive to antibiotic treatment) were observed in 10/73 patients.
Conclusions: The introduction and availability of smaller instruments have led to safer use of percutaneous endoscopy and ureteroscopy in children, with results and complications comparable to those in adults . The availabilty of ESWL may improve the outcomes of pediatric stone treatment.As a consequence, the availability of adequate minimally invasive instruments is of paramount importance to safely manage these delicate patients.