Laparoscopic and retroperitoneoscopic approach for pediatric renal and ureteric stones: a single center experience

Bruno Nicolino Cezarino, Marcos Gianetti Machado ,Roberto Iglesias Lopes, Lorena Oliveira, Miguel Srougi, Francisco Tibor Dénes

University of São Paulo School of Medicine, Division of Urology, Pediatric Unit

Background

•Nephrolithiasis has become increasingly prevalent in children, raising from 6% to 10% annually in the past 25 years

•Up to 17% of pediatric calculi are classically managed by open surgeryVan Dervoort et al; J Urol 2007

Standard treatment procedures for pediatric population are similar to adult populationFragoso AC et al, J pediatrUrol 2009

ESWL

Ureterorrenoscopy

PCNL

Background

Laparoscopic management of urolithiasis is well documented in the adult literature, but lacks adequate evidence in pediatric population

Valla JS et al J pediatrUrol 2009

Indications

Pielic calculi with extra-renal pelvis

Ureteral calculi

UPJ obstruction with calculus

Special Indications

Staghorn Calculus

Caliceal Calculus

Results Retrospective analysis 12 patients

Transperitoneal pyelolithotomy

Retroperitoneoscopic pielolithotomy

Laparoscopic ureterolithotomy

Pieloplasty + calculi removal

N=3 N=2 N=3 N=4

Average operative time = 168 minutesAverage hospital stay = 2,1 daysStone free rate = 91,6%( 11/12)Average blood loss = 45 ml

procedures median age stone free conversion rate complications

Agrawal, et al 22 7(5-12) 95,45%(21/ 22) 4,55% ( 1) 1 urinary leak

Casale, et al 8 4(3-10) 100% none none

Fragoso, et al 9 N/A 55%( 5/ 9) none noneLee, et al 5 16.6 80% (4/5) 20% (1) none

Cezarino, et al 12 11 91.6% ( 11/ 12) none none

Conclusions

Laparoscopic and retroperitoneoscopic approach is safe and feasible in children, even in the presence of urological abnormalities such as UPJ obstruction, with success rates equivalent to other more invasive procedures classically used to treat stones in pediatric population.

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