Ain Shams University Faculty of Medicine, Egypt.
Ain Shams University Faculty of Medicine, Egypt.
J Pediatr Urol. 2024 Aug;20(4):605.e1-605.e8. doi: 10.1016/j.jpurol.2024.05.019. Epub 2024 May 25.
With improvements in endoscopic surgery, open surgical procedures for urinary system stones have cleared the path for the use of less invasive treatment modalities in patients with pediatric kidney stone disease. Extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS) are among the treatment options available.
To prospectively evaluate the outcomes of mini-percutaneous nephrolithotomy and retrograde intrarenal surgery (RIRS) for children ≤10 years of age with upper urinary tract calculus (1-2.5 cm).
Sixty pediatric patients with single or multiple renal stones (1-2.5 cm in diameter) were collected prospectively and equally divided into two groups to undergo RIRS or mini-PCNL. The operative and postoperative outcomes of both groups were analyzed.
The groups' mean ages and genders were comparable. The mean stone size for the RIRS group was 1.86 cm and 1.69 cm for the PCNL group (P = 0.449). The PCNL group had statistically longer mean fluoroscopy and hospitalization times. The stone-free rates (SFRs) after a single procedure were 27 (90%) in the PCNL group and 25 (83.33%) in the RIRS group (P = 0.706). The UAS was placed in 13 (43.33%) patients in the RIRS group. In the RIRS group, 14 (46.67%) children required preoperative DJ stent application to passively dilate the ureteric orifice. As regard post DJ stenting, 13 (46%) cases applied DJ in the mini PCNL group. major complications were observed in either group. Minor complication (Clavien 1-3) rates were 16.66% and 13.33% for the PCNL and RIRS groups, respectively. There were no differences found between the RIRS and mini-PCNL groups regarding operative time. The mean cost of RIRS was $703.96 and $537.03 for the mini-PCNL.
According to the results of this study, mini-PCNL and RIRS are effective procedures for treating renal stones in children up to 2.5 cm with comparable success and complication rates. Hospital stay, radiation exposure, and fluoroscopy time are significantly lower in RIRS than in the mini PCNL technique. Although RIRS is effective, a major disadvantage is the greater requirement for JJ stent insertion either before or after the procedure and the consequent need for a second procedure for removal.
随着内镜手术的进步，泌尿系统结石的开放性手术为儿童肾结石疾病患者提供了更微创的治疗选择。体外冲击波碎石术（ESWL）、经皮肾镜取石术（PCNL）和逆行性肾内手术（RIRS）是可供选择的治疗方法之一。
前瞻性评估微创经皮肾镜取石术和逆行性肾内手术（RIRS）治疗儿童（≤10 岁）上尿路结石（1-2.5cm）的结果。
前瞻性收集了 60 名患有单个或多个肾结石（直径 1-2.5cm）的儿科患者，并将其平均分为两组，分别接受 RIRS 或 mini-PCNL 治疗。分析两组的手术和术后结果。
两组的平均年龄和性别相当。RIRS 组的平均结石大小为 1.86cm，PCNL 组为 1.69cm（P=0.449）。PCNL 组的平均透视和住院时间明显更长。单次手术后的无结石率（SFR）在 PCNL 组为 27 例（90%），在 RIRS 组为 25 例（83.33%）（P=0.706）。RIRS 组中有 13 例（43.33%）患者放置了输尿管支架。在 RIRS 组中，14 名（46.67%）儿童需要术前 DJ 支架应用来被动扩张输尿管口。在 DJ 支架放置后，13 例（46%）mini-PCNL 组应用 DJ 支架。两组均未出现主要并发症。PCNL 和 RIRS 组的轻微并发症（Clavien 1-3）发生率分别为 16.66%和 13.33%。两组的手术时间无差异。RIRS 的平均费用为 703.96 美元，mini-PCNL 为 537.03 美元。
根据本研究结果，mini-PCNL 和 RIRS 是治疗儿童 2.5cm 以下肾结石的有效方法，成功率和并发症发生率相当。RIRS 比 mini-PCNL 技术的住院时间、辐射暴露和透视时间明显更短。尽管 RIRS 有效，但一个主要缺点是在手术前后需要更大程度地插入 JJ 支架，因此需要进行第二次手术取出。
