Softness KA. et al., 2022: Pediatric Stone Surgery: What Is Hot and What Is Not.
Softness KA, Kurtz MP.
Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, USA.
Abstract
Purpose of review: We aim to highlight recent advances in technology and techniques for surgical management of urinary tract calculi in pediatric patients.
Recent findings: Percutaneous nephrolithotomy (PCNL) is classically performed in the prone position. The supine PCNL was first attempted to overcome the shortcomings of difficult airway access, patient and surgeon discomfort. The supine PCNL, and subsequent modifications, has been successfully described in the pediatric population. Classically, PCNL has also been classically concluded with obligate placement of a nephrostomy tube and bladder catheter. Recently, tubeless and totally tubeless PCNL reduces pain and duration of hospitalization with satisfactory surgical outcomes in children. Finally, we describe the use of thulium laser technology, which offers improved efficacy in stone treatment and may supplant the current dominant technologies in coming years. Recent advances in pediatric stone surgery include supine PCNL, miniaturized PCNL instrumentation, tubeless procedures, and thulium laser technology.
Curr Urol Rep. 2022 Feb 8. doi: 10.1007/s11934-022-01089-7. Online ahead of print. PMID: 35133545 Review.
Comments 1
In this review the authors discuss recent developments in paediatric stone treatment. Like in several other reports it is obvious that SWL still is very alive for this patient group.
Although it is stated that SWL is “first line treatment” in children there has been no technical development of this method and accordingly SWL is mentioned only briefly in the introduction.
As for adults, decisions on appropriate treatment are based on:
Stone size
Stone composition
Stone location
Available equipment
Surgeon’s experience
The last point really needs to be emphasized.
The authors also state that stenting is necessary for treatment of large stones. I think, however, that within the range of appropriate indications for SWL, most children can be treated without an internal stent. Their ureters allow passage of fragments much better than ureters in adults.
Hans-Göran Tiselius