Department of Pediatric Urology, University of Florence, Meyer Hospital, Florence, Italy.
Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy.
Urologia. 2022 May;89(2):298-303. doi: 10.1177/03915603211026101. Epub 2021 Aug 2.
Ureteropelvic Junction Obstruction (UPJO) is the most common congenital ureteral anomaly. Nowadays, according to the increasing incidence of urolithiasis, 20% of children with UPJO presents urolithiasis. Open pyeloplasty was the standard treatment before the introduction of minimally invasive surgery (MIS). Nevertheless, only scattered experiences on MIS were previously described and universal agreement on the treatment of UPJO plus urolithiasis is still missing.
The study aim was to describe our experience with a series of pediatric patients affected by UPJO and urolithiasis treated with robot-assisted pyeloplasty (RAP) and endoscopic removal of stones using a flexible cystoscope and a stones basket in a singular tertiary referral center.
We retrospectively reviewed our data from pediatric patients affected by UPJO and urolithiasis undergoing RAP between April 2013 and December 2019. The analysis was conducted on seven patients. All procedures were performed by one expert robotic surgeon and one endoscopic surgeon skilled in the management of urolithiasis.
The mean age was 7 years (IQR 4-16). The median stone area was 77.7 mm two (IQR 50.2-148.4). Most of them (71.4%) presented preoperative symptoms. The median operative time was 110 min (IQR 104-125) with a console time of 90 (IQR 90-105). The median length of stay was 5 days (IQR 4-5). Median follow-up was 16 months (IQR 10-25).
RAP with concomitant flexible ureteroscope is a safe and effective option for the simultaneous management of UPJO with urolithiasis with excellent outcomes in children.
肾盂输尿管连接部梗阻（UPJO）是最常见的先天性输尿管异常。如今，随着尿路结石发病率的增加，20%的 UPJO 患儿伴有尿路结石。开放肾盂成形术是微创外科（MIS）引入前的标准治疗方法。然而，在此之前仅描述了一些关于 MIS 的零星经验，对于 UPJO 合并尿路结石的治疗仍未达成普遍共识。
本研究旨在描述我们在一家三级转诊中心，使用机器人辅助肾盂成形术（RAP）和经软性膀胱镜及取石篮在内镜下一次性处理 UPJO 和尿路结石的一系列小儿患者的经验。
我们回顾性分析了 2013 年 4 月至 2019 年 12 月期间接受 RAP 治疗的 UPJO 合并尿路结石的小儿患者的数据。共纳入 7 例患者。所有手术均由一位经验丰富的机器人外科医生和一位熟练处理尿路结石的内镜外科医生共同完成。
患者平均年龄为 7 岁（IQR 4-16）。结石面积中位数为 77.7mm²（IQR 50.2-148.4）。大多数患者（71.4%）有术前症状。中位手术时间为 110 分钟（IQR 104-125），控制台时间为 90 分钟（IQR 90-105）。中位住院时间为 5 天（IQR 4-5）。中位随访时间为 16 个月（IQR 10-25）。
RAP 联合软性输尿管镜是治疗 UPJO 合并尿路结石的安全有效的方法，小儿患者的结局良好。
