Aula ministrada para congresso da SIUP 2015 sobre experiencia em uso de laparoscopia para tratamento de calculos em crianças.

1. 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

2. 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 surgery
Van Dervoort et al; J Urol 2007
Standard treatment procedures for pediatric population are similar to adult population
Fragoso AC et al, J pediatrUrol 2009
ESWL
Ureterorrenoscopy
PCNL

3. 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

4. Indications
Pielic calculi with extra-renal pelvis
Ureteral calculi
UPJ obstruction with calculus

5. Special Indications
Staghorn Calculus
Caliceal Calculus

6. 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 minutes
Average hospital stay = 2,1 days
Stone free rate = 91,6%( 11/12)
Average blood loss = 45 ml

7. 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 none
Lee, et al 5 16.6 80% (4/5) 20% (1) none
Cezarino, et al 12 11 91.6% ( 11/ 12) none none

8. 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.

9. Thank You!
www.brunocezarino.com