Aula congresso Sociedade Iberoamericana de Uropediatria
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Transcript of Aula congresso Sociedade Iberoamericana de Uropediatria
Laparoscopic and retroperitoneoscopic approach for pediatric renal and ureteric stones: a single center experience
Bruno Nicolino Cezarino, Marcos Gianetti Machado ,Roberto Iglesias Lopes, Lorena Oliveira, Miguel Srougi, Francisco Tibor Dénes
University of São Paulo School of Medicine, Division of Urology, Pediatric Unit
Background
•Nephrolithiasis has become increasingly prevalent in children, raising from 6% to 10% annually in the past 25 years
•Up to 17% of pediatric calculi are classically managed by open surgeryVan Dervoort et al; J Urol 2007
Standard treatment procedures for pediatric population are similar to adult populationFragoso AC et al, J pediatrUrol 2009
ESWL
Ureterorrenoscopy
PCNL
Background
Laparoscopic management of urolithiasis is well documented in the adult literature, but lacks adequate evidence in pediatric population
Valla JS et al J pediatrUrol 2009
Indications
Pielic calculi with extra-renal pelvis
Ureteral calculi
UPJ obstruction with calculus
Special Indications
Staghorn Calculus
Caliceal Calculus
Results Retrospective analysis 12 patients
Transperitoneal pyelolithotomy
Retroperitoneoscopic pielolithotomy
Laparoscopic ureterolithotomy
Pieloplasty + calculi removal
N=3 N=2 N=3 N=4
Average operative time = 168 minutesAverage hospital stay = 2,1 daysStone free rate = 91,6%( 11/12)Average blood loss = 45 ml
procedures median age stone free conversion rate complications
Agrawal, et al 22 7(5-12) 95,45%(21/ 22) 4,55% ( 1) 1 urinary leak
Casale, et al 8 4(3-10) 100% none none
Fragoso, et al 9 N/A 55%( 5/ 9) none noneLee, et al 5 16.6 80% (4/5) 20% (1) none
Cezarino, et al 12 11 91.6% ( 11/ 12) none none
Conclusions
Laparoscopic and retroperitoneoscopic approach is safe and feasible in children, even in the presence of urological abnormalities such as UPJ obstruction, with success rates equivalent to other more invasive procedures classically used to treat stones in pediatric population.
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