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Aula congresso Sociedade Iberoamericana de Uropediatria
- 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.