Yuruk E, Tuken M, Gonultas S, Colakerol A, Cakir O O, Binbay M, Sarica K, Muslumanoglu A Y
Department of Urology, Bagcilar Research and Training Hospital, Istanbul, Turkey.
Department of Urology, Bagcilar Research and Training Hospital, Istanbul, Turkey.
J Pediatr Urol. 2017 Oct;13(5):487.e1-487.e5. doi: 10.1016/j.jpurol.2017.01.015. Epub 2017 Feb 21.
To investigate the efficacy and safety of retrograde intrarenal surgery (RIRS) in the treatment of pediatric cystine stones.
Data of the pediatric patients who underwent RIRS for kidney stones were retrospectively evaluated. A total of 14 children with cystine stones managed with RIRS were identified. In addition to the patient demographics and stone characteristics, all retrospectively obtained operative data were evaluated and discussed in detail, with an emphasis on the success and complication rates.
Mean age of the 14 cases was 10.9 ± 2.2 years (range: 7-15). Mean stone size was 13.6 ± 2.4 mm (range: 10-18) (Summary table). Of these stones, four were located in the renal pelvis, three were in the lower, three were in the middle and the remaining four were located in upper calyx. Ureteral access sheath was used in 12 (85.7%) patients. The double-J ureteral stent was placed pre-operatively in one case and was inserted postoperatively in 12 cases. Mean operation time was 38.2 ± 7.2 min (range: 30-50). Complications were observed in two cases: mild ureteral laceration in the first and fever on the second postoperative day in the second patient. All of the patients were stone free on sonographic evaluation at the 4-week follow-up evaluation. Although potassium citrate treatment was initiated in 11 patients, tiopronin treatment was initiated in four patients for recurrence prophylaxis during long-term follow-up. During a mean follow-up period of 25.7 ± 5.2 months, stone recurrence was noted in one patient.
Treatment of patients with cystine stones is challenging, due to high risk of rapid recurrence in the presence of residual fragments. Besides allowing complete stone clearance in all cases in the current series, RIRS is a highly reproducible method that can be safely performed, even in recurrences. The major limitations of the current study were low number of patients and short follow-up period.
The results clearly indicated that RIRS is a safe treatment modality in the management of pediatric cystine stones.
探讨逆行性肾内手术（RIRS）治疗小儿胱氨酸结石的疗效及安全性。
对接受RIRS治疗肾结石的小儿患者的数据进行回顾性评估。共确定了14例接受RIRS治疗的胱氨酸结石患儿。除患者人口统计学资料和结石特征外，对所有回顾性获得的手术数据进行了详细评估和讨论，重点是成功率和并发症发生率。
14例患者的平均年龄为10.9±2.2岁（范围：7 - 15岁）。平均结石大小为13.6±2.4毫米（范围：10 - 18毫米）（汇总表）。其中，4枚结石位于肾盂，3枚位于下盏，3枚位于中盏，其余4枚位于上盏。输尿管通路鞘在12例（85.7%）患者中使用。双J输尿管支架在1例患者术前放置，12例患者术后放置。平均手术时间为38.2±7.2分钟（范围：3～50分钟）。观察到2例并发症：第1例为轻度输尿管撕裂，第2例患者术后第2天发热。在4周的随访评估中，所有患者超声检查均无结石残留。虽然11例患者开始使用柠檬酸钾治疗，但4例患者开始使用硫普罗宁治疗以预防长期随访中的复发。在平均25.7±5.2个月的随访期内，1例患者出现结石复发。
由于存在残留碎片时快速复发的风险较高，胱氨酸结石患者的治疗具有挑战性。除了在本系列所有病例中实现完全结石清除外，RIRS是一种高度可重复的方法，即使在复发情况下也能安全进行。本研究的主要局限性是患者数量少和随访期短。
结果清楚地表明，RIRS是治疗小儿胱氨酸结石的一种安全治疗方式。
