Department of Urology, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital, Ancona, Italy.
Pediatric Surgery Unit, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital and "G. Salesi" Children's Hospital, Ancona, Italy.
Int J Med Robot. 2021 Jun;17(3):e2246. doi: 10.1002/rcs.2246. Epub 2021 Mar 7.
OBJECTIVE(S): The incidence of urinary tract stone disease is steadily increasing in both adult and paediatric populations. This condition develops due to different factors: dietary or metabolic alterations, infection, and congenital anatomic malformations. Standard indications and treatments for children are analogous to the ones indicated for adults. Extracorporeal shock wave lithotripsy, ureterorenoscopy and percutaneous nephrolithotomy (PCNL) should be preferred to more invasive techniques. Moreover, the introduction of laparoscopic and robot-assisted laparoscopic approaches have improved surgical outcomes, lowering the bleeding risk with higher stone-free rates, even in complicated cases. Despite these well-known improvements, there are few reports regarding laparoscopic robot-assisted management for urinary tract stone disease in paediatric patients under the age of 10, especially with concomitant treatment of ureteropelvic junction obstruction and multiple calyceal stones.
PATIENT AND METHOD(S): A 4-year-old child was referred for recurrent right abdominal flank pain, macroscopic haematuria and a previous history of urinary tract infections. A computed tomography of the abdomen showed right ureteropelvic junction obstruction associated with multiple unilateral stones located in the renal pelvis and in the interpolar renal calyces. Due to its complexity, we held a multidisciplinary meeting with paediatric surgeons and nephrologists to determine optimal treatment. As a result, a combined robot-assisted laparoscopic pyeloplasty (LP) and renal calculi holmium laser lithotripsy using a digital flexible ureteroscope through an abdominal robotic trocar was performed. No post-surgical complications were recorded, and the patient was discharged within 48 h following surgery. At subsequent regular follow-up examinations over a period of 24 months, no signs of recurrence were detected for both ureteropelvic junction obstruction and stone disease.
RESULT(S): Robot-assisted LP with concomitant laser lithotripsy is a reasonable treatment option for designated young paediatric patients with challenging ureteropelvic junction obstruction complicated by urolithiasis, especially in cases where stones are not amenable with standard procedures.
成人和儿科人群的尿路结石病发病率稳步上升。这种情况是由于不同的因素引起的：饮食或代谢改变、感染和先天性解剖畸形。儿童的标准适应证和治疗方法与成人相同。体外冲击波碎石术、输尿管镜检查和经皮肾镜取石术（PCNL）应优先于更具侵袭性的技术。此外，腹腔镜和机器人辅助腹腔镜技术的引入改善了手术结果，降低了出血风险，结石清除率更高，即使在复杂病例中也是如此。尽管有这些众所周知的改进，但对于 10 岁以下儿童尿路结石病的腹腔镜机器人辅助管理，尤其是合并治疗肾盂输尿管连接部梗阻和多发性肾盂结石的报道很少。
一名 4 岁儿童因反复发作性右腰肋部疼痛、肉眼血尿和以前的尿路感染病史而就诊。腹部 CT 显示右侧肾盂输尿管连接部梗阻伴多发性单侧结石，位于肾盂和肾盏间。由于其复杂性，我们与小儿外科医生和肾病学家举行了多学科会议，以确定最佳治疗方案。结果，通过腹部机器人 trocar 使用数字柔性输尿管镜进行了机器人辅助腹腔镜肾盂成形术（LP）和肾结石钬激光碎石术的联合治疗。术后无并发症发生，患者在术后 48 小时内出院。在随后的 24 个月定期随访检查中，未发现肾盂输尿管连接部梗阻和结石病复发的迹象。
对于伴有结石病的复杂肾盂输尿管连接部梗阻的特定年轻儿科患者，机器人辅助 LP 联合激光碎石术是一种合理的治疗选择，特别是对于标准方法无法处理的结石病例。
