Parikh Yashaswi, Shaikh Sami, Aghababian Aznive, Saxena Sonam, Abdulfattah Suhaib, Ai Emily, Nadeem Iqra, Uppaluri Curran, Eftekharzadeh Sahar, Weaver John, Godlewski Karl, Fischer Katherine, Long Christopher, Mittal Sameer, Shukla Aseem, Srinivasan Arun
Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA.
Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, Philadelphia, PA, USA.
J Pediatr Urol. 2025 Feb;21(1):29-34. doi: 10.1016/j.jpurol.2024.09.009. Epub 2024 Sep 19.
Ureteroscopy (URS) for urolithiasis in pediatric patients may be particularly challenging for patients with co-morbidities that increase the risk for stone formation and recurrence. Patients with neurogenic bladders (NGB) and/or patients that are non-ambulatory are reported to have higher rates of additional comorbidities and a particularly increased risk of developing urolithiasis, and higher rates of infections and post-operative complications.
To report outcomes of URS for stone disease in pediatric patients with NGB and/or non-ambulatory status and compare these outcomes to patients without these co-morbidities.
An IRB-approved prospective single institutional registry was used to retrospectively identify all patients under 18 years of age who underwent URS for stone disease between July 2012 and July 2021, excluding bladder stones. Patients were categorized in two groups: patient with NGB with or without non-ambulatory status versus all other patients (control). Baseline demographics, pre-operative radiologic imaging, intra-operative details, and post-operative outcomes including 30-day complications were aggregated and compared between the two groups.
275 URS in 198 patients were performed during the study period, and 49 (18 %) of these were performed on patients with NGB. Pre-operative imaging showed significantly higher number of stones (3 vs 2, p = 0.003) and larger total stone burden in patients with NGB than those without NGB (15 mm vs 9 mm, p = 0.009). Patients with NGB had a significantly longer length of procedure (86 vs 60 min, p = 0.002), increased need for staged procedures, increased length of stay (1 vs 0 days, p < 0.001), and increased use of an extended duration of antibiotics prior to the procedure (<0.001). There was no difference in need for passive dilation, stent placement, or other intra-operative parameters. There was no statistical difference in the incidence of 30-day complications between the two groups post-operatively. However, there was a higher incidence of febrile UTIs (8.2 % vs 1.3 %, p = 0.021) in patients with NGB and a lower incidence of pain related complications (0 % vs 9.3 %, p = 0.032). Patients with NGB had a higher incidence of requiring ipsilateral URS for recurrent stone disease within a year of surgery (34.6 % vs 18.9 %, p = 0.01).
The results show that URS for urolithiasis can be done safely and effectively in pediatric patients with neurogenic bladders. The increased risk of infectious complications within 30 days of surgery warrants careful pre- and post-operative antibiotic care plan for this patient population.
对于患有增加结石形成和复发风险的合并症的儿科患者，输尿管镜检查（URS）治疗尿路结石可能特别具有挑战性。据报道，患有神经源性膀胱（NGB）的患者和/或非行走患者有更高的其他合并症发生率，患尿路结石的风险尤其增加，以及更高的感染率和术后并发症发生率。
报告URS治疗患有NGB和/或非行走状态的儿科患者结石疾病的结果，并将这些结果与没有这些合并症的患者进行比较。
使用经机构审查委员会（IRB）批准的前瞻性单机构登记系统，回顾性识别2012年7月至2021年7月期间接受URS治疗结石疾病的所有18岁以下患者，不包括膀胱结石。患者分为两组：有或无非行走状态的NGB患者与所有其他患者（对照组）。汇总并比较两组之间的基线人口统计学、术前放射学成像、术中细节以及包括30天并发症在内的术后结果。
在研究期间，对198例患者进行了275次URS，其中49例（18%）是对患有NGB的患者进行的。术前成像显示，与没有NGB的患者相比，患有NGB的患者结石数量显著更多（3个对2个，p = 0.003），总结石负荷更大（15毫米对9毫米，p = 0.009）。患有NGB的患者手术时间明显更长（86分钟对60分钟，p = 0.002），分期手术的需求增加，住院时间延长（1天对0天，p < 0.001），并且术前使用抗生素的时间延长（<0.001）。在被动扩张、支架置入或其他术中参数方面没有差异。两组术后30天并发症的发生率没有统计学差异。然而，患有NGB的患者发热性尿路感染的发生率更高（8.2%对1.3%，p = 0.021），与疼痛相关并发症的发生率更低（0%对9.3%，p = 0.032）。患有NGB的患者在手术后一年内因复发性结石疾病需要同侧URS的发生率更高（34.6%对18.9%，p = 0.01）。
结果表明，对于患有神经源性膀胱的儿科患者，URS治疗尿路结石可以安全有效地进行。手术30天内感染并发症风险增加，这就需要为该患者群体制定仔细的术前和术后抗生素护理计划。
