軟式輸尿管鏡碎石手術處理兒科上尿路結石之單一中心之經驗

周敬哲、林政鋒、劉冠麟、陳文祥、林承家、陳鴻毅、吳翊豪

基隆長庚紀念醫院 外科部 泌尿科

Retrograde intrarenal surgery for upper urinary tract urolithiasis in pediatric patients –A single center experience

Ching-Che Chou, Cheng-Feng Lin, Kuan-Lin Liu, Wen-Hsiang Chen, Cheng-Chia Lin, Hung Yi Chen, Yi-Hao Wu

Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan

Purpose:  Review the results of treating upper tract urolithiasis with flexible ureteroscopy in the pediatric population in a single medical institution in Taiwan

Materials and methods:  All pediatric patients with upper tract urolithiasis and treated with flexible ureteroscopy in the timespan of November 2015 to August 2022 were identified.  Retrospective analysis of demographics, preoperative, intraoperative and postoperative details were recorded using electronic charts.   Stone free status was defined as absence of residual fragments on follow up images.

Results:  A total of 13 retrograde intrarenal surgeries were performed in 10 children with a mean age of 10.92 years.  The median stone burden using cumulative stone diameter(CSD) was 15mm (Range 4.5 – 103mm).  8 of 13 cases (61.54%) received preoperative ureteral stenting.  Ureteral access sheath placement was successful in 12 of 13 cases (92.31%) and all patients(100%) underwent successful RIRS with FURS in a median operation time of 81 minutes and a median hospital stay of 3 days.  Stone free status was achieved in 9 patients with an overall stone-free rate(SFR) of 69.2%.  Stratified by size, SFR of up to 88.89% was achieved in children with CSD < 5cm and 100% in the same group if the embedded renal parenchymal stones were excluded. No intraoperative complications were noted and 1(7.69%) had post-operative urosepsis.

Conclusions:  Advancements in RIRS allowed for its wide-spread use in treating upper tract urolithiasis in the pediatric population. It is both safe and effective under strictly guided scenarios.