Therapeutic ureteroscopy for urolithiasis in children younger than 60 months of age

Nerli, Rajendra B; Sharma, Manas; Gupta, Pranay; Adhikari, Priyabrata; Bidi, Saziya; Ghagane, Shridhar C

doi:10.1007/s00383-020-04777-y

Cited by 7 publications

(6 citation statements)

References 17 publications

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“…In a study of 30 paediatric patients treated for KSD, Ferretti et al 23 found an overall SFR of 93.3% when including re-intervention and a low rate of major complications. Similarly, Nerli et al 24 in their study of 77 patients less than 60 months of age while suggesting URS as first line of treatment for paediatric urolithiasis found a SFR of 94.8% with an overall complication rate of 12.9%.…”

Section: Discussionmentioning

confidence: 76%

Outcomes of ureteroscopy for management of stone disease in early and late childhood over a 15-year period

Mani

Pietropaolo

Madarriaga

et al. 2022

Therapeutic Advances in Urology

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Background: Although paediatric ureteroscopy is widely performed, there is still a lack of data and outcomes in early childhood. In this two-centre study, we compared the outcomes of ureteroscopy for stone disease management in early and late childhood and provide outcomes for the same. Methods: Data was retrospectively collected on consecutive patients from two tertiary paediatric endo-urology European centres over a 15-year period (2006–2021). Patients were split into two groups, namely, early childhood (age ⩽ 9 years) and late childhood (age 9 to ⩽16 years). Outcomes including stone-free rate (SFR) and complications were compared between these two groups. Results: A total of 148 patients underwent 184 procedures (1.2 procedure/patient) during the study period (66 in early childhood and 82 in late childhood). The mean age in early and late childhood groups were 5.6 and 13.3 years, and a male: female ratio of 1.6:1 and 1.1:1, respectively. The SFR and complications in early and late childhood groups were 87.8% and 90.2% ( p = 0.64) and 5.7% and 4.1%, respectively. Conclusion: Paediatric ureteroscopy and laser stone fragmentation achieves good results in both early and late childhood with comparable SFRs, although the complications and need for second procedure were marginally higher in the early childhood group. Our study would set up a new benchmark for patient counselling in future, and perhaps this needs to be reflected in the paediatric urolithiasis guidelines.

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Section: Discussionmentioning

confidence: 76%

Outcomes of ureteroscopy for management of stone disease in early and late childhood over a 15-year period

Mani

Pietropaolo

Madarriaga

et al. 2022

Therapeutic Advances in Urology

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“…However, in this study, before the ureteroscopy procedure, dilatation of the ureter was required first. 12 It is challenging and risky to advance a ureteroscope into the non-dilated ureter; failure to do might result in the procedure's failure. 13 A systematic review by Rob S, et al showed equally high SFRs and safety profiles of URS in pediatrics may be attained by medium-volume centers as well as large-volume centers, hence encouraging expanded URS use in facilities that do fewer operations annually.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Preoperative Tamsulosin on Ureteroscopy Access in Pediatrics: A Systematic Review and Meta-Analysis

Singgih,

Oktaviani,

Pranowo Sampurno Secodiningrat

et al. 2023

Siriraj Med J

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Objective: The incidence of urolithiasis in pediatrics increases to 4-10% annually. One of the methods for treating urolithiasis is ureteroscopy (URS). The small anatomy in pediatrics often makes the initial URS unsuccessful. Alpha blockers, a drug that can relax the ureteral muscles, is a therapy that can be considered before URS is carried out. The objective of this study is to evaluate the efficacy of preoperative tamsulosin for URS access in pediatrics. Materials and Methods: We conducted a search using four databases, including PubMed, EBSCO, Cochrane Library, and ProQuest. This study includes randomized controlled trials (RCTs), retrospective and prospective studies, which compared the efficacy of preoperative alpha blockers and placebo or non-placebo controls in pediatrics undergoing ureteroscopy. The outcome of interest was the success rate of URS access and the duration of surgery. Results: A total of 120 studies were identified from a database search. There were 3 studies included in this review involving 235 patients. The meta-analysis was conducted using a random-effects model. The results of the meta-analysis showed that alpha blockers provided a successful rate of ureteroscopy access in pediatric patients (Odds ratio (OR) 2.73; 95% confidence interval (CI) 1.52 up to 4.91; p=0.0008). Duration of surgery did not show significant results (Mean difference (MD) 3.46; 95% CI -3.59 up to 10.50; p=0.34).

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“… 25 , 29 , 30 Moreover, some studies provide no clear definition. 31 , 32 Future recommendations from guideline and society groups would help standardise outcome reporting to facilitate comparison of results across different studies.…”

Section: Discussionmentioning

confidence: 99%

Ureteroscopy for stone disease in the paediatric population: lessons learned and outcomes in a Nordic setting

Juliebø‐Jones

Æsøy

Gjengstø

et al. 2022

Therapeutic Advances in Urology

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Introduction: Paediatric stone disease is rare in the Nordic communities. Still, the condition can require surgical intervention in the form of ureteroscopy (URS). Here, we report outcomes achieved at a regional (tertiary) centre. Patients and methods: Retrospective analysis was performed of consecutive patients (<18 years of age) undergoing URS for stone disease between 2010 and 2021. Outcomes of interest included stone-free rate (SFR) determined using a definition of no residual fragments ⩾ 3 mm on imaging and complications classified according to Clavien–Dindo system. Results: In total, 23 patients underwent 47 URS procedures for a total of 31 stone episodes. Mean age was 9 (range 1–17) years and male-to-female ratio was 6:17. Overall, 35% had at least one medical comorbidity. Ultrasound determined preoperative stone status in 87%. Mean largest index and cumulative stone sizes were 9 (range 3–40) and 12 (range 3–40) mm, respectively. Overall, 32% had multiple stones. Lower pole was the commonest stone location (39%). No patients underwent elective pre-operative stenting. Ureteral access sheaths were not used in any cases. Access to upper urinary tract at first procedure was successful in 94%. Initial and final SFR was 61% and 90%, respectively. No intra-operative complications were recorded. Overall post-operative complication rate was 17.5%. Urinary tract infection (CD II) was the commonest adverse event (12.5%). Conclusion: Paediatric URS can be delivered in the setting of a regional centre without compromising outcomes. This includes when carried out by adult endourologists, without routine pre-stenting and omitting use of ureteric access sheath.

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Therapeutic ureteroscopy for urolithiasis in children younger than 60 months of age

Cited by 7 publications

References 17 publications

Outcomes of ureteroscopy for management of stone disease in early and late childhood over a 15-year period

Outcomes of ureteroscopy for management of stone disease in early and late childhood over a 15-year period

The Efficacy of Preoperative Tamsulosin on Ureteroscopy Access in Pediatrics: A Systematic Review and Meta-Analysis

Ureteroscopy for stone disease in the paediatric population: lessons learned and outcomes in a Nordic setting

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