Publication: Endoscopic combined intrarenal surgery versus percutaneuos nephrolithotomy for complex pediatric stone disease: A comparative analysis of efficacy and safety.
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Date
2024-05-31
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Abstract
Introduction
Decision-making for complex pediatric urinary system
stone disease is still a challenge for pediatric
urologists. The interest in supine percutaneous
nephrolithotomy (PCNL) is increasing among centers
to achieve high surgical success rates with less
morbidity. Despite advanced retrograde intrarenal
surgery armamentarium, percutaneous approaches
remain the first-line surgical treatment modality for
>2 cm and complex renal stones. There are no
comparative studies yet in the literature for pediatric
endoscopic combined intrarenal surgery
(ECIRS)
Objective
In this study, we aimed to contribute to the literature
by evaluating the safety and efficacy of ECIRS
by comparing it with PCNL.
Study design
Patients under 18 years of age who underwent PCNL
and ECIRS for urinary tract stone disease at our Pediatric
Urology department between 2012 and 2024
were included. Preoperative (demographic characteristics,
stone characteristics, biochemical parameters),
perioperative (duration of surgery, number of
accesses, lasing and fluoroscopy times, endoscopic
and fluoroscopic stone-free rates) and postoperative
(hospital stay, urinary tract infection, complication
and radiological stone-free rates) parameters were
retrospectively evaluated.
Results
A total of 68 children [28 (41%) girls and 40 (59%)
boys] aged 5 (0e17) years were included in the
study. ECIRS was performed in 19 (28%), supine in 28
(41%) and prone PCNL in 21 (30%) patients. Age
(p Z 0.029), Guy’s stone score (p < 0.001),
S.T.O.N.E. (p < 0.001), and Seoul National University
Renal Stone Complexity (S-ReSC) scores (p Z 0.001)
for preoperative parameters were found to be
higher in ECIRS group over both PCNL methods
(Summary Table). However, Clinical Research Office
of the Endourological Society (CROES) score was
seen lower for ECIRS group patients compared to
other groups (p Z 0.028).
Surgery time (in favor of supine over prone
PCNL), fluoroscopy time (in favor of ECIRS and Supine
PCNL over Prone PCNL), preferred laser type
(prone PCNL group was mostly performed with holmium
laser, whereas other groups were balanced
between Holmium and Thulium Fiber Laser) and exit
strategy (the preferred exit strategy was DJ Stent in
most of the ECIRS patients, whereas nephrostomy
tube was used in some of the PCNL group) showed
significant difference among the groups as perioperative
parameters (p Z 0.042, <0.001, <0.001,
<0.001, respectively). Surgery time was lower for
supine PCNL compared to prone PCNL. For postoperative
parameters, stone-free rates, complication
rates and urinary tract infections were similar
between the 3 groups, while a difference was
detected in terms of length of hospital stay in favor
of ECIRS over both supine and prone PCNL
(p Z 0.006).
Discussion
The current trial suggests that stone-free and
complication rates of ECIRS and supine PCNL were
similar in the pediatric complex stone patients.
Although, the stones in the ECIRS group we found to
be more complex. Also, ECIRS was superior to PCNL
in terms of fluoroscopy exposure and hospital stay.
Conclusion
With the widespread use of new generation ureteral
access sheaths and flexible ureterorenoscopes,
ECIRS may have an important role in treatment of
complex pediatric kidney stones.
Description
Keywords
Tıp, Cerrahi Tıp Bilimleri, Üroloji, Pediatrik Üroloji, Sağlık Bilimleri, Medicine, Surgery Medicine Sciences, Urology, Pediatric Urology, Health Sciences, Klinik Tıp (MED), Klinik Tıp, ÜROLOJİ VE NEFROLOJİ, CERRAHİ, Clinical Medicine (MED), CLINICAL MEDICINE, UROLOGY & NEPHROLOGY, SURGERY, Cerrahi, Nefroloji, Surgery, Nephrology, Children, Kidney stone, PCNL, ECIRS, Stone free rate, Complication
Citation
Tanidir Y., Sekerci Ç. A., Genc Y. E., Gokmen E., Arslan F., Yucel S., Tarcan T., Cam K., "Endoscopic combined intrarenal surgery versus percutaneuos nephrolithotomy for complex pediatric stone disease: A comparative analysis of efficacy and safety.", Journal of pediatric urology, 2024