Ha Darren, Harris Kelly T, Rove Kyle O
Pediatric Urology Research Enterprise, Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, United States.
Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States.
Front Urol. 2023 Apr 18;3:1150795. doi: 10.3389/fruro.2023.1150795. eCollection 2023.
With advances in therapeutic interventions, endourology has become standard of care for the treatment of numerous diseases in the field of pediatric urology. However, there remains a lack of agreement and evidence on the optimal approaches and associated complications of endourological treatment of upper urinary tract conditions in children, namely ureteropelvic junction (UPJ) obstruction, primary obstructive megaureter, and nephrolithiasis. While pyeloplasty remains the first-line surgical treatment for pediatric UPJ obstruction, endoscopic retrograde balloon dilatation (ERBD) and endopyelotomy continue to gain traction as less invasive means of treating obstruction, particularly for failed repairs. Studies report success rates ranging from 76-100% although re-stenosis or need for revision surgery is not uncommon. Endourological options for the surgical management of primary obstructive megaureter include ERBD or endoureterotomy, rather than the open option of ureteroneocystotomy with or without tapering. Both have shown long-term success rates ranging from 70-90%, however, there is emerging evidence that these therapies may be associated with a risk of postoperative vesicoureteral reflux. Meanwhile, for stone disease, shock wave lithotripsy (SWL), flexible ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL) are mainstays in the pediatric urologist's armamentarium. Studies have shown that URS and PCNL have comparable stone-free rates, although PCNL can be associated with increased morbidity. Advancements in technology have led to the use of smaller access sheaths without compromising stone-free rates or increasing long-term complications. The use of mini-PCNL in the adult population holds great potential for use in our pediatric patients. The rise of endourology expertise and improved technology makes it an attractive option that could even be considered as a first-line option for the treatment of various urinary tract conditions. Nevertheless, there is a paucity of evidence on outcomes and complications following its use for treatment of upper urinary tract diseases in children. This review aims to summarize and present results of endourological treatments for pediatric UPJ obstruction, primary obstructive megaureter, and nephrolithiasis, as well as highlight advancements in the field of endourology that may increase its utilization in pediatric urology in the future.
随着治疗干预技术的进步，腔内泌尿外科已成为小儿泌尿外科领域众多疾病治疗的标准方法。然而，对于儿童上尿路疾病（即输尿管肾盂连接部（UPJ）梗阻、原发性梗阻性巨输尿管和肾结石）的腔内泌尿外科治疗的最佳方法及相关并发症，仍缺乏共识和证据。虽然肾盂成形术仍然是小儿UPJ梗阻的一线手术治疗方法，但内镜逆行球囊扩张术（ERBD）和肾盂内切开术作为治疗梗阻的侵入性较小的方法，越来越受到关注，特别是对于修复失败的情况。研究报告的成功率在76%至100%之间，尽管再狭窄或需要再次手术并不罕见。原发性梗阻性巨输尿管手术治疗的腔内泌尿外科选择包括ERBD或输尿管内切开术，而不是有或没有缩窄的输尿管膀胱再植术这种开放手术。两者都显示出70%至90%的长期成功率，然而，越来越多的证据表明这些治疗可能与术后膀胱输尿管反流的风险有关。同时，对于结石疾病，冲击波碎石术（SWL）、软性输尿管镜检查（URS）和经皮肾镜取石术（PCNL）是小儿泌尿外科医生的主要治疗手段。研究表明，URS和PCNL的结石清除率相当，尽管PCNL可能会增加发病率。技术的进步导致使用更小的穿刺鞘，而不影响结石清除率或增加长期并发症。成人使用迷你PCNL在我们的小儿患者中具有很大的应用潜力。腔内泌尿外科专业知识的增加和技术的改进使其成为一个有吸引力的选择，甚至可以被视为治疗各种尿路疾病的一线选择。然而，关于其用于治疗儿童上尿路疾病后的结果和并发症的证据很少。本综述旨在总结并展示小儿UPJ梗阻、原发性梗阻性巨输尿管和肾结石的腔内泌尿外科治疗结果，并强调腔内泌尿外科领域的进展，这些进展可能会增加其在未来小儿泌尿外科中的应用。
