Azili Mujdem Nur, Ozcan Fatma, Tiryaki Tugrul
Ankara Child Diseases Hematology and Oncology Education and Research Hospital, Pediatric Surgery Clinic, Ziraat mah, İrfan Basbug cad. Kurtdereli sok, No:4 Diskapi, Ankara, Turkey.
Ankara Child Diseases Hematology and Oncology Education and Research Hospital, Pediatric Surgery Clinic, Ziraat mah, İrfan Basbug cad. Kurtdereli sok, No:4 Diskapi, Ankara, Turkey.
J Pediatr Surg. 2014 Jul;49(7):1161-5. doi: 10.1016/j.jpedsurg.2013.12.023. Epub 2014 Jan 13.
Retrograde intrarenal surgery (RIRS) is a known option for the treatment of upper tract calculi with an excellent success. However, the reports of RIRS in prepubertal children are limited. In this study, we evaluated the factors which affected the success rate and the complications of RIRS at renal stone treatment in childhood.
We retrospectively reviewed the records of children under 14 years old who underwent RIRS for renal stone disease between January 2009 and December 2012. Patients' age, gender, body mass index (BMI), stone size, stone location, stone number, intraoperative complications, stone free status, postoperative complications were recorded.
There were 80 ureterorenoscopic procedures performed in 58 renal units of 47 children (23 males and 24 females). The patients' ages ranged from 8 months to 14 years (mean age 4.7 ± 3.4 years). There was a difference in the distribution of symptoms in age groups. UTI was higher in the 1-4 years age group, abdominal pain was seen mostly in children aged 5-14 years. Multiple stones (included staghorn stone) were noted in 60.4% of patients. In 27.6% of patients, ureteral stones were accompanied by renal stones in our series. In the infancy group, cystine and staghorn stones were more frequently seen, mostly bilateral. After a single ureteroscopic procedure for intrarenal stones in children, we achieved stone free status in 50.9% of the ureters (n=26). After the repeated sessions, the stone clearance rate reached to 85.1%.
Retrograde intrarenal surgery can be used as a first line therapy to treat renal stones in children. This is especially important if an associated ureteral stone is present that requires treatment; or in patients with cystinuria, which is not favorably treated with ESWL. Complications were seen more frequently in patients with cystine stones. Extravasation was noted more frequently in patients admitted with UTIs. There was a significant relationship between the conversion to open procedures and the age groups, with most procedures occurring in infancy. The parents should be informed about the probability of multiple procedures to achieve stone free status.
逆行性肾内手术（RIRS）是治疗上尿路结石的一种已知选择，成功率很高。然而，关于青春期前儿童RIRS的报道有限。在本研究中，我们评估了影响儿童肾结石治疗中RIRS成功率及并发症的因素。
我们回顾性分析了2009年1月至2012年12月期间接受RIRS治疗肾结石疾病的14岁以下儿童的病历。记录患者的年龄、性别、体重指数（BMI）、结石大小、结石位置、结石数量、术中并发症、结石清除情况、术后并发症。
47名儿童（23名男性和24名女性）的58个肾单位共进行了80次输尿管镜手术。患者年龄从8个月至14岁（平均年龄4.7±3.4岁）。各年龄组症状分布存在差异。1-4岁年龄组尿路感染发生率较高，5-14岁儿童腹痛最为常见。60.4%的患者有多发结石（包括鹿角形结石）。在我们的系列研究中，27.6%的患者输尿管结石伴有肾结石。在婴儿组中，胱氨酸结石和鹿角形结石更为常见，大多为双侧。儿童单次输尿管镜治疗肾内结石后，50.9%的输尿管（n=26）实现了结石清除。经过多次治疗后，结石清除率达到85.1%。
逆行性肾内手术可作为治疗儿童肾结石的一线疗法。如果存在需要治疗的相关输尿管结石；或者对于胱氨酸尿症患者（ESWL治疗效果不佳），这一点尤为重要。胱氨酸结石患者并发症更为常见。尿路感染患者外渗更为常见。转为开放手术与年龄组之间存在显著关系，大多数手术发生在婴儿期。应告知家长为实现结石清除可能需要多次手术。
