Endoscopic cystolithotomy by mini nephroscope: A preliminary study

Percutaneous cystolithotomy for pediatric endemic bladder stone: experience with 155 cases from 2 developing countries

Objective: To analyze the biochemical composition and biochemical types ofurinary bladder stones in children. Study design and setting: Observational study, Departmentof Pediatric Surgery, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad.Place and Duration: One year duration from January to December 2006. Materials &Methods: A sample of 30 children was selected according to criteria of inclusion of age <10years of urinary bladder stones without any anomaly. Urinary bladder stones were washed indistilled H2O deionized to remove contaminations. Urinary bladder stones were dried at 1000C for overnight in an oven. The urinary bladder stones cut into pieces were used for the FTIRspectroscopy analysis, carried out on “Nicolet Avatar 330 FTIR spectrophotometer”. Data wasanalyzed on SPSS 22.0 at 95% confidence interval. Results: Of 30, 6 (20%) were female and24 (80%) were male. The male dominancy was noted with male to female ratio of 4:1. Mean±SD age was noted as 4.839 + 2.819 years. Urinary stones of pure and mixed biochemistrywere noted in 5 (16.6%) and 25 (83.3%) respectively (P=0.0001). Most frequent urinary bladderstone found was the calcium oxalate monohydrate - ammonium hydrogen urate. Conclusions:Most frequent type of urinary bladder stones was the calcium oxalate monohydrate–ammoniumhydrogen urate type in the children.

Purpose: The study aimed to assess the outcome and safety of PCCL in the pediatric population coming with bladder stones in developing countries.
 Methodology: Patients of pediatric age with vesical calculus were evaluated for PCCL. Department of Peads Urology Institute of Kidney Diseases Thirty participants were included in the single center study, with enrollment beginning in January 2000 and ending in August 2021. General anesthesia was used for the operation. Following a cystoscopy examination, a suprapubic puncture was performed, and the urethral tract was dilated to a maximum of 26 Fr. Pneumatic lithotripsy was used to break up the stone. A nephroscope was used to see where it was lodged so it could be removed. A percutaneous urethral catheter was inserted was taken out after 48 postoperative hours.
 Findings: The patients' median age was 4.1 (1-10). Patients tended to be men. The typical size of a gem was 10.1 millimeters. The average operational time to successfully remove the stones was just 30 minutes. Hematuria, infection, and mild mucosal damage were the only serious complications seen during or after surgery, and all were treated conservatively. Ammonium acid urate comprised the bulk of the stones and the nucleus in 26 cases (86%). Percutaneous suprapubic lithotripsy is a tested and reliable method with a high success rate for treating bladder stones in children. The procedure is short and has few adverse effects.

This study aimed to compare the safety and efficacy of laser lithotripsy and pneumatic lithotripsy, the two most commonly used transurethral lithotripsy methods for treating bladder stones in children in Iraq. Between January 2013 and December 2016, 64 children with bladder stones were included in this prospective randomized study, after ethical committee approval and written consent from the children’s parents or caregivers were obtained. Patients were assigned randomly by computer software to two groups treated with either pneumatic cystolithotripsy or laser lithotripsy. A 9 Fr. semirigid ureteroscope was used to pass the lithotripter through and fragment the stone. A catheter of 8–12 Fr. was then introduced and kept in place for 24 h. All children were hospitalized for 24 h, and the catheter was removed the next morning. Outpatient follow-up was maintained for 6–12 months. In terms of operation outcomes and complications, the laser lithotripsy group had a significantly longer duration of operation (74.5 ± 26.6 min vs. 51.5 ± 17.2 min, p = 0.001), whereas the number of patients requiring an extended hospital stay was significantly higher in the pneumatic lithotripsy group (48.5% vs. 16.1%, p = 0.006). Moreover, pneumatic lithotripsy was associated with a significantly greater risk of having at least one adverse effect (64% greater than that in the laser group). Stone clearance rates did not significantly differ between treatment groups. In conclusion, both pneumatic and laser lithotripters can be used to treat children with bladder stones with high efficacy and safety.

Infrared spectroscopic analysis of urinary stones (including stones induced by melamine-contaminated milk powder) in 189 Chinese children

Urolithiasis is a condition where crystalline mineral deposits (stones) form within the urinary tract. Urinary stones can be located in any part of the urinary tract. Affected children may present with abdominal pain, blood in the urine or signs of infection. Radiological evaluation is used to confirm the diagnosis, to assess the size of the stone, its location, and the degree of possible urinary obstruction.To assess the effects of different medical and surgical interventions in the treatment of urinary tract stones of the kidney or ureter in children.We searched the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid) as well as the World Health Organization International Clinical Trials Registry Platform Search Portal and ClinicalTrials.gov. We searched reference lists of retrieved articles and conducted an electronic search for conference abstracts for the years 2012 to 2017. The date of the last search of all electronic databases was 31 December 2017 and we applied no language restrictions.We included all randomised controlled trials (RCTs) and quasi-RCTs looking at interventions for upper urinary tract stones in children. These included shock wave lithotripsy, percutaneous nephrolithotripsy, ureterorenoscopy, open surgery and medical expulsion therapy for upper urinary tract stones in children aged 0 to 18 years.We used standard methodological procedures according to Cochrane guidance. Two review authors independently searched and assessed studies for eligibility and conducted data extraction. 'Risk of bias' assessments were completed by three review authors independently. We used Review Manager 5 for data synthesis and analysis. We used the GRADE approach to assess the quality of evidence.We included 14 studies with a total of 978 randomised participants in our review, informing eight comparisons. The studies contributing to most comparisons were at high or unclear risk of bias for most domains.Shock wave lithotripsy versus dissolution therapy for intrarenal stones: based on one study (87 participants) and consistently very low quality evidence, we are uncertain about the effects of SWL on stone-free rate (SFR), serious adverse events or complications of treatment and secondary procedures for residual fragments.Slow shock wave lithotripsy versus rapid shock wave lithotripsy for renal stones: based on one study (60 participants) and consistently very low quality evidence, we are uncertain about the effects of SWL on SFR, serious adverse events or complications of treatment and secondary procedures for residual fragments.Shock wave lithotripsy versus ureteroscopy with holmium laser or pneumatic lithotripsy for renal and distal ureteric stones: based on three studies (153 participants) and consistently very low quality evidence, we are uncertain about the effects of SWL on SFR, serious adverse events or complications of treatment and secondary procedures.Shock wave lithotripsy versus mini-percutaneous nephrolithotripsy for renal stones: based on one study (212 participants), SWL likely has a lower SFR (RR 0.88, 95% CI 0.80 to 0.97; moderate quality evidence); this corresponds to 113 fewer stone-free patients per 1000 (189 fewer to 28 fewer). SWL may reduce severe adverse events (RR 0.13, 95% CI 0.02 to 0.98; low quality evidence); this corresponds to 66 fewer serious adverse events or complications per 1000 (74 fewer to 2 fewer). Rates of secondary procedures may be higher (RR 2.50, 95% CI 1.01 to 6.20; low-quality evidence); this corresponds to 85 more secondary procedures per 1000 (1 more to 294 more).Percutaneous nephrolithotripsy versus tubeless percutaneous nephrolithotripsy for renal stones: based on one study (23 participants) and consistently very low quality evidence, we are uncertain about the effects of SWL on SFR, serious adverse events or complications of treatment and secondary procedures.Percutaneous nephrolithotripsy versus tubeless mini-percutaneous nephrolithotripsy for renal stones: based on one study (70 participants), SFR are likely similar (RR 1.03, 95% CI 0.93 to 1.14; moderate-quality evidence); this corresponds to 28 more per 1,000 (66 fewer to 132 more). We did not find any data relating to serious adverse events. Based on very low quality evidence we are uncertain about secondary procedures.Alpha-blockers versus placebo with or without analgesics for distal ureteric stones: based on six studies (335 participants), alpha-blockers may increase SFR (RR 1.34, 95% CI 1.16 to 1.54; low quality evidence); this corresponds to 199 more stone-free patients per 1000 (94 more to 317 more). Based on very low quality evidence we are uncertain about serious adverse events or complications and secondary procedures.Based on mostly very low-quality evidence for most comparisons and outcomes, we are uncertain about the effect of nearly all medical and surgical interventions to treat stone disease in children.Common reasons why we downgraded our assessments of the quality of evidence were: study limitations (risk of bias), indirectness, and imprecision. These issues make it difficult to draw clinical inferences. It is important that affected individuals, clinicians, and policy-makers are aware of these limitations of the evidence. There is a critical need for better quality trials assessing patient-important outcomes in children with stone disease to inform future guidelines on the management of this condition.

Pediatric urolithiasis is a globally growing problem. The composition and frequency of urinary tract stones vary not only among different countries, but across various regions in a country. Hence, we aimed to identify the types and frequencies of urinary tract stones in children from our region (Inner Western Anatolian part of Turkey), and to compare our findings with the results from other regions in our country. In this retrospective analysis of 53 pediatric urolithiasis cases that were treated in our hospital between 2009 and 2019, the demographic data, clinical course, radiological and metabolic findings, the recurrence rate, and the composition of the stones were evaluated. The mean age of the patients was 5.9±4.6 (0.5-18) years, and there were 30 (56.6%) girls and 23 (43.4%) boys. An analysis of the composition of the stones revealed that the majority (85%) consisted of calcium oxalate. The highest risk of recurrence and the need for multiple shockwave lithotripsy (SWL) sessions or surgical intervention appeared to be related with the presence of whewellite stones, which are the most challenging stones in childhood. According the study results, the urinary stone types vary across different regions in our country, and the frequency of uric acid stones decreased going westward, while the frequency of oxalate stones increased. We conclude that this difference in the frequency of the type of urinary stones might reflect the regional dietary habits. Regional frequency and etiology studies for the types of urolithiasis may facilitate the approach to the treatment of urolithiasis.

Pathologie pleurale

With the advancement in endoscopic technology, the discovery of novel endoscopic techniques such as endoscopic full-thickness resection (EFTR) provides new contents for natural orifice transluminal endoscopic surgery (NOTES) and endoscopic...

Within 12 years, 165 cases of urolithiasis were observed at the Children's University Hospital of Teheran. The incidence of urolithiasis amounts to 1 case in 300 paediatric hospitalizations. 160 calculi from 121 children were analysed by various methods: semiquantitative chemical analysis (Mercognost), x-ray diffraction, polarising microscopy on thin sections. In about 25% of the cases metabolic disorders or malformations were found responsible for urolithiasis. In 100 cases, stone formation was attributed to the upper and in 21 cases to the lower urinary tract. Calcium oxalates are the most frequent constituents, followed by ammonium acid urate. The core of the stones in the upper tract was mostly composed of calcium oxalate. Ammonium acid urate was the second important core component, but occurred especially enriched in the lower urinary tract. On the basis of these and literature data, the lack of ammonium acid urate in juvenile stones in Europe and the USA seems surprising. Thus, it must be assumed therefore, that ammonium acid urate is a key to understanding the formation of endemic calculi. The cases studied support that with increasing standard of living, the incidence of bladder stones decreases.

443 - Treatment of bladder stones in children: A systematic review on behalf of the EAU Urolithiasis Guideline Panel

Context: We will try to show an outline of the clinical and biological characteristics of pediatric urolithiasis among Tunisian children in the coastal region. Materials and Methods: This retrospective study included 168 children below 16 years (100 boys and 68 girls) presented with urinary stones. Patients were reviewed in a multi-centric study with regard to age at diagnosis, sexual, historical, physical, laboratory, and radiologic findings. The physical and chemical analysis of stones was carried out by a stereomicroscope and infra-red spectroscopy respectively. Statistical Analysis: Statistical analysis of data was carried out using software SPSS 11.0 for Windows. Statistical significance was determined using chi-square test. Results: The sex ratio was 1.47. Clinical presentation of this pathology was dominated by abdominal pain (28%), hematuria (25.6%), dysuria (16.7%) and urinary tract infection (14.3%). Stones were located in the upper urinary tract in 75.6% of cases. Of the urine cultures, 14.3% were positive. Whewellite is found more frequently in children stones than infants (P Conclusions: The male prevalence of pediatric urolithiasis is less obvious in Tunisia. Calcium oxalate is the most frequent chemical compound in Tunisian pediatric urolithiasis.

The treatment of upper urinary tract stones is one of the main urological activities. Endoscopic surgical techniques, namely semirigid or flexible ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL), represent a major therapeutic modality, alternatively to chemolysis, extracorporeal shock wave lithotripsy and open, laparoscopic or robotic-assisted surgery. In this article, the specificities of these endoscopic techniques, their clinical performances, as well as their development following recent technological advances are discussed.

We assessed the potential of dual-energy computed tomography (CT) for the differentiation between uric acid (UA)-containing and non-UA-containing urinary stones. Forty urinary stones of 16 different compositions in two sizes (<and>or=5 mm) were examined in an ex vivo model. Thirty stones consisted of pure calcium oxalate (whewellite or wheddellite), calcium phosphate (apatite, brushite, or vaterite), ammonium magnesium phosphate (struvite), UA, ammonium acid urate, ammonium phosphate, sodium hydrogen urate, or cystine, and ten stones were of mixed composition (UA-sodium hydrogen urate, whewellite-urate, wheddellite-urate, whewellite-brushite, or whewellite-brushite-struvite). Scans were performed using dual-source CT in a dual-energy mode with the tubes simultaneously operating at 80 and 140 kV. Two readers analysed the data with respect to stone attenuation at each energy level. The stones were classified as UA- or non-UA-containing using manual attenuation measurements and software analysis results. Sensitivity, specificity, PPV, and NPV were calculated using crystallographic stone analysis as the gold standard. Twenty-six out of 40 stones (65%) contained no UA; 14 stones (35%) contained UA. When compared with UA-containing stones, the differences in attenuation values at 80 and 140 kV were significantly (P<0.001) higher in stones containing no UA. The software automatically mapped 39/40 stones (98%). Only one (2%) 2 mm UA-stone was missed. The software correctly classified all detected stones as UA- or non-UA-containing. The attenuation values of the missed stone were manually plotted into the analysis sheet which allowed for the correct classification of the stone (containing UA). Therefore, the sensitivity, specificity, PPV, and NPV for the detection of UA-containing stones was 100%. Ex vivo experience indicates that differentiation between UA- and non-UA-containing stones can be accurately performed using dual-source dual-energy CT.

We present our experience with micropercutaneous cystolithotripsy (mPCCL) using transillumination-guided access in children with bladder stones and evaluate the safety and efficacy of this procedure. Twelve children who underwent mPCCL for bladder stone removal in our department between January 2011 and September 2013 were included in this study. Percutaneous access was performed using the transillumination technique. The chief complaint, age and sex of the patients, stone size, operative time, complications, stone-free rate, and stone composition as determined by radiography diffraction analysis were recorded. The mean age of the patients was 2.6 (1-7) years. One out of 12 patients was a girl. The mean stone size was 14 mm (7-32 mm). The mean mPCCL procedure time was 38.7 (15-65) minutes. The mean hospital stay was 1.4 (0.5-4) days. The stone-free rate after one mPCCL intervention was 91.6% and increased to 100% after two sessions of mPCCL. The notable complications were transient macroscopic hematuria in one patient, acute urinary retention in one patient, and the need for a second session of mPCCL in another patient. The stones were composed of calcium oxalate (3), ammonium acid urate (1), calcium phosphate (1), cystine (1), struvite (1), and unknown (5). Transillumination-guided mPCCL is a safe and effective technique, does not require the use of ionizing radiation, is technically easy, and is a minimally invasive alternative for the management of bladder stones. It has many advantages, especially in pediatric patients, such as decreased urethral injury, no need for postoperative catheter insertion in most cases, and shorter operative time.