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Azili MN et al, 2015: Management of stone disease in infants.

Azili MN, Ozturk F, Inozu M, Çayci FŞ, Acar B, Ozmert S, Tiryaki T.
Department of Pediatric Surgery, Ankara Child Diseases Hematology and Oncology Education and Research Hospital, No:10 Diskapi, 06110, Ankara, Turkey.

Abstract

Evaluating and treating renal stone disease in infants are technically challenging. In this study, we evaluated the surgical treatment of renal stones in children under 1 year of age. We retrospectively reviewed the records of patients under 1 year old who were treated with ESWL, endourological or open surgical procedures for renal stone disease between January, 2009 and December, 2012. The patients' age, gender, stone size, stone location and number, complications, stone-free status, and postoperative complications were recorded. 19 of 121 infants with a mean age of 10.2 ± 3.07 months were treated with surgical procedures. Six (75 %) of eight cystinuria patients required a surgical intervention. Retrograde endoscopic management was performed in thirteen patients (63.4 %) as an initial surgical approach. There were three major (15.7 %) complications. The rate of open surgical procedures was 31.6 % (6 of 19 infants). The cutoff value of stone size for open surgery was 10 mm. There was a significant relationship between the conversion to open procedures and stone size, stone location, and symptom presentation especially the presence of obstruction (p < 0.05). After repeated treatments, the stone clearance rate of RIRS reached 84.6 %. Retrograde intrarenal surgery is an effective and safe treatment method for renal stones in infants and can be used as a first-line therapy in most patients under 1 year old. This is especially important if an associated ureteral stone or lower pole stone that requires treatment is present and for patients with cystinuria, which does not respond favorably to ESWL.

Urolithiasis. 2015 Jun 3. [Epub ahead of print]

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Comments 1

Hans-Göran Tiselius on Monday, 07 September 2015 08:02

This retrospective report is a description of treatment results in infants with methods selected by the operators. It is obvious that the authors´ preference was to use RIRS despite the fact that 65% of the children required pre-stenting to dilate the ureter and that 93% had stents inserted at the end of the RIRS procedure. This means that in a considerable number of the children three sessions of general anaesthesia were necessary. In this regard it seems as if SWL, even with repeated sessions, would have been a reasonable alternative. In contrast, 13 of the 19 children were initially treated with RIRS, 3 with open surgery, and 2 with PNL. SWL obviously was not commonly used and mentioned in only one patient after PNL. Other authors would have preferred SWL or ultra-mini PNL as primary treatment alternatives.

The authors´ negative experience with SWL for cystine stones is surprising and might be based on literature results of SWL in adults. It is my own experience, that cystine stones in young children have a rather brittle morphology, probably as a result of a short stone history. Also cystine stones in children should be a possible indication for SWL.

It is possible that in this group of young children non-invasiveness would be beneficial for the future course of their disease. But the successful use of SWL requires a lithotripter constructed for easy treatment of small children.

This retrospective report is a description of treatment results in infants with methods selected by the operators. It is obvious that the authors´ preference was to use RIRS despite the fact that 65% of the children required pre-stenting to dilate the ureter and that 93% had stents inserted at the end of the RIRS procedure. This means that in a considerable number of the children three sessions of general anaesthesia were necessary. In this regard it seems as if SWL, even with repeated sessions, would have been a reasonable alternative. In contrast, 13 of the 19 children were initially treated with RIRS, 3 with open surgery, and 2 with PNL. SWL obviously was not commonly used and mentioned in only one patient after PNL. Other authors would have preferred SWL or ultra-mini PNL as primary treatment alternatives. The authors´ negative experience with SWL for cystine stones is surprising and might be based on literature results of SWL in adults. It is my own experience, that cystine stones in young children have a rather brittle morphology, probably as a result of a short stone history. Also cystine stones in children should be a possible indication for SWL. It is possible that in this group of young children non-invasiveness would be beneficial for the future course of their disease. But the successful use of SWL requires a lithotripter constructed for easy treatment of small children.
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