With the increase of the prevalence of pediatric urolithiasis (1-5%), retrograde intrarenal surgery (RIRS) is emerging as the preferred option for the management of stones in pediatric patients. Although the principles of RIRS developed in adults can be applied in children, also expert adult endourologists feel uncomfortable approaching young patients due to a long learning curve that usually is expected to be required in this particular setting. The aim of the study was to compare peri and postoperative outcomes of RIRS in pediatric and adult patients performed by a single surgeon expert in adult endourology (>500 RIRS) with no experience in pediatric urology.
Indeed, in our center since July 2015 an interhospital center was created between the pediatric hospital and the adult hospital for the technologies improvement of pediatric urology. In this setting, every complex pediatric case of urolithiasis or ureteropelvic junction obstruction or megaureter was discussed in a multidisciplinary team involving a pediatric urologist, pediatric nephrology, a radiologist and an endourologist or a mini invasive surgeon of the adult field. According to our background, we collected data on patient characteristics of 30 consecutive patients (15 adults and 15 children) undergoing RIRS at our institution were collected retrospectively from January 2016 to October 2018. The mean age for the pediatric group was 11.8 years (IQR 8-16) and the adult group was 56 years (IQR 49-58). No significative differences between the two groups in terms of peri and postoperative outcomes were found. The most common complication was hematuria in 2/30 patients (1 child vs 1 adult) and fever 2/30 (1 pediatric patient vs 1 adult) (p=1.00) that required antibiotic treatment (Clavien Dindo 2). The median length of stay was 1 day (IQR: 1-1days) in both groups (p=1.00). Stone free rate was 86.7% in children and 80% in adults (p=0.624).
All these findings showed that, although pediatric RIRS remains challenging, surgeons that have achieved high expertise in the adult field could confidently approach the pediatric age population with efficacy and safety comparable with adults, even in his first series, as seen for other surgical minimally invasive procedures.
However, our study has some limitations that we should report. This is only a preliminary experience and, although the number of cases performed by the surgeon is equal, it remains a small series. The aim was to compare the outcomes of the initial procedures performed in children by an expert surgeon with those performed in the same period time in adults in order to encourage more endourologists to approach pediatric patients with more confidence in an era when stone diseases are becoming a real social problem in children, as well.
In conclusion, our preliminary experience suggests that expert adult endourologist can also manage pediatric cases successfully with results comparable to adults and low complication rates.
Written by: Simone Sforza, MD, Department of Pediatric Urology, University of Florence, Meyer Hospital, Department of Oncologic, Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy.
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