Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
Division of Pediatric Urology, Meyer Children Hospital, Florence, Italy.
Urolithiasis. 2021 Dec;49(6):575-583. doi: 10.1007/s00240-021-01271-5. Epub 2021 May 16.
This study aimed to report a multi-institutional experience with robot-assisted laparoscopic surgery (RALS) for treatment of urinary tract stones in children. The medical records of 15 patients (12 boys), who underwent RALS for urolithiasis in 4 international centers of pediatric urology over a 5-year period, were retrospectively collected. The median patient age was 8.5 years (range 4-15). Eleven/fifteen patients (73.3%) had concurrent uretero-pelvic junction obstruction (UPJO) and 2/15 patients (13.3%) had neurogenic bladder. Stones were in the renal pelvis in 8/15 (53.3%), in the lower pole in 3/15 (20%), in the bladder in 2/15 (13.3%), and in multiple locations in 2/15 (13.3%). One patient (6.6%) had bilateral multiple kidney stones. The median stone size was 10.8 mm (range 2-30) in upper tract location and 27 mm (range 21-33) into the bladder. Eleven patients with concomitant UPJO underwent simultaneous robot-assisted pyelolithotomy and pyeloplasty in 12 kidney units. Two patients with isolated staghorn stones received robot-assisted pyelolithotomy. Robot-assisted cystolithotomy was performed in two patients with bladder stones. The median operative time was 131.8 min (range 60-240). The stone-free rate was 80% following initial surgery and 100% after secondary treatment. Clavien 2 complications (hematuria, infections) were recorded in 5/15 patients (33.3%). Three/fifteen patients (20%) with residual renal stones were successfully treated using ureterorenoscopy (Clavien 3b). RALS was a feasible, safe and effective treatment option for pediatric urolithiasis in selected cases such as large bladder stones, bilateral kidney stones, staghorn stones or concomitant anomalies such as UPJO requiring simultaneous pyeloplasty.
本研究旨在报告一项多机构经验，即使用机器人辅助腹腔镜手术（RALS）治疗儿童尿路结石。回顾性收集了 4 个国际儿童泌尿外科中心在 5 年内对 15 例（12 名男孩）接受 RALS 治疗尿石症的患者的病历。中位患者年龄为 8.5 岁（范围 4-15 岁）。11/15 例（73.3%）患者并发肾盂输尿管连接部梗阻（UPJO），2/15 例（13.3%）患者患有神经性膀胱。15 例结石中，肾盂结石 8 例（53.3%），下极结石 3 例（20%），膀胱结石 2 例（13.3%），多处结石 2 例（13.3%）。1 例（6.6%）患者双侧多发性肾结石。上尿路结石的中位结石大小为 10.8mm（范围 2-30），膀胱结石的中位结石大小为 27mm（范围 21-33）。11 例并发 UPJO 的患者在 12 个肾脏单位中同时行机器人辅助肾盂切开取石和肾盂成形术。2 例孤立性鹿角结石患者接受机器人辅助肾盂切开取石术。2 例膀胱结石患者行机器人辅助膀胱切开取石术。中位手术时间为 131.8 分钟（范围 60-240）。初次手术后结石清除率为 80%，二次治疗后为 100%。15 例患者中有 5 例（33.3%）出现 Clavien 2 级并发症（血尿、感染）。3/15 例（20%）有残余肾结石的患者通过输尿管镜检查（Clavien 3b）成功治疗。对于某些特定病例，如大膀胱结石、双侧肾结石、鹿角结石或需要同时行肾盂成形术的并发畸形（如 UPJO），RALS 是一种可行、安全且有效的治疗选择。
