Retroperitoneoscopic pyelolithotomy: a good alternative treatment for renal pelvic calculi in children

Abstract

_______________________________________________________________________________________Introduction: Nephrolitiasis, once considered an adult disease, has become increasingly prevalent in children, with an increase from 6% to 10 % annually in past 25 years. Kidney stones in pediatric population can result from metabolic diseases in up to 50% of children affected. Other factors associated with litiasis are infection, dietary factors, and anatomic malformations of urinary tract. Standard treatment procedures for pediatric population are similar to adult population. Extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS), percutaneous nepfrolithotomy (PCNL), as well as laparoscopic and retroperitoneoscopic approaches can be indicated in selected cases. The advantages of laparoscopic or retroperitoneoscopic approaches are shorter mean operation time, no trauma of renal parenchyma, lower bleeding risk, and higher stone-free rates, especially in pelvic calculi with extrarenal pelvis, where the stone is removed intact. Patient and Methods: A 10 year-old girl presented with right abdominal flank pain, macroscopic hematuria,with previous history of urinary infections.. Further investigation showed an 1,5 centimeter calculi in right kidney pelvis. A previous ureterorenoscopy was tried with no success, and a double J catheter was placed. After discussing options, a retroperitoneoscopic pielolithotomy was performed. Results: The procedure occurred with no complications, and the calculi was completely removed. The foley catheter was removed in first postoperative day and she was discharged 2 days after surgery. Double J stent was removed after 2 weeks. Conclusions: Retroperitoneoscopic pielolithotomy is a feasible and safe procedure in children, with same outcomes of the procedure for adult population.

Laparoscopic surgery in pediatric upper tract urolithiasis: An alternate modality

“…There are some studies describing laparoscopic approach in adults, but very few studies describing use of laparoscopy in children with urolithiasis are available in English literature. [ 2 3 4 5 6 ] Apart from the known advantages of laparoscopy such as shorter hospital stay and better cosmesis as compared to open surgery, it is a radiation-free procedure with complete stone clearance under single anesthesia. Soltani et al .…”

“…[ 9 ] Most of the studies available in pediatric urolithiasis describe transperitoneal approach, may be because it allows more space and greater freedom of movement. [ 2 6 10 11 ] In author's view, retroperitoneal approach provides direct access to the urinary tract and the chances of postoperative adhesive obstruction are minimal as there is no breach in the peritoneal cavity. There are less chances of vascular injury when dealing with intrarenal pelvis and in cases requiring extended pelvic incisions.…”

Editorial Coment: Retroperitoneoscopic Pyelolithotomy: A Good Alternative Treatment for Renal Pelvic Calculi in Children

“…This video Cezarino et al (1) was very well about a retroperitoneal laparoscopic pyelolithotomy. While executed flawlessly, the applicability of this video to the average urologic practice is limited because of the other treatments readily available that are usually exhausted prior to laparoscopic stone surgery.…”