Summary
Introduction and objective
Endourological and percutaneous approaches are the standard of care for treatment
of pediatric urolithiasis. However, in certain situations, an endoscopic-assisted
robotic pyelolithotomy (EARP) can be an acceptable alternative. Limited data exist on
pediatric EARP; thus, the authors describe their experience.
Methods
Patient selection: The authors retrospectively analyzed the records of all robotic
procedures performed at five institutions from 7/09–10/17 to identify patients who
underwent EARP. The authors collected demographics data, indications, operative time,
and postoperative complications. Stone composition was reported as the majority composition
(≥50%), unless any uric acid or struvite was noted, and those stones were classified
as such.
Technique
Through a traditional or hidden incision endoscopic surgery (HIdES) robot pyeloplasty
approach, the authors are able to easily pass a flexible endoscope through a robotic
trocar and into the renal collecting system to perform pyeloscopy or ureteroscopy.
Stones were primarily retrieved via the pyelolotomy and, if indicated, treated with
laser lithotripsy.
Results
The authors identified 26 patients who underwent EARP in 27 renal units. Median patient
age was 12.2 years (interquartile range [IQR] 6.1–14.5 years), and body mass index
was 17.5 kg/m2 (IQR 16.5–25.4 kg/m2). The median pre-operative dimension of the largest stone was 9.0 mm (IQR 5.8 mm–15.0 mm).
Reasons for EARP: 21 (77.8%) concomitant pyeloplasty, four (14.8%) altered anatomy
precluding other techniques, and two (7.4%) multiple large stones. Multiple stones
were present in 20 renal units (74.1%). Stones were located in the renal pelvis in
nine (33.3%), lower pole in 10 (37.0%), ureter in one (3.7%), and multiple locations
in seven (25.9%). Hidden incision endoscopic surgery approach was used in 14 (51.9%),
and the median operative time was 237.5 min (IQR 189.8–357.8 min) with a median length
of stay 1.0 day (IQR 1.0–2.0 days). Stone composition included calcium oxalate in
14 (51.9%), calcium phosphate in five (18.5%), cysteine in two (7.4%), struvite in
two (7.4%), and unknown in four (14.8%). Overall stone free status was 19 (70.4%);
of the eight (29.6%) renal units with residual stones, four underwent ureteroscopy,
two extracorporeal shockwave lithotripsy (ESWL), one spontaneously passed, and one
underwent percutaneous nephrolithotomy (PCNL). After secondary treatment, final stone
free rate was 96.3%. Complications included stent migration and admission for urosepsis.
At a median follow-up of 12 months (IQR 6.2–19.2 months), five (18.5%) had stone recurrence.
Conclusions
Graphical AbstractExtrarenal view of the operative field from the laparoscopic camera depicting the
flexible nephroscope in the renal pelvis performing nephroscopy.
Keywords
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Article info
Publication history
Published online: December 19, 2019
Accepted:
December 12,
2019
Received:
August 5,
2019
Identification
Copyright
© 2019 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
