軟式輸尿管鏡結石碎石手術在兒童結石的處置-案例分析
吳翊豪 吳俊德 陳文祥 黃賢祥 林政鋒 林承家
基隆長庚紀念醫院 泌尿外科 外科部
Retrograde intrarenal surgery in the management of pediatric urolithiasis - case series
Yi-Hao Wu, Cheng-Feng Lin, Chun-Te Wu, Wen-hsiang Chen, Shian-shiang Huang, Cheng-Chia Lin
Department of urology, Chang Gung Memorial Hospital, Keelung, Taiwan
Purpose:
To evaluate the retrograde intrarenal surgery (RIRS) in the management of pediatric urolithiasis
Introduction:
Other than open surgical intervention for stone management, minimally invasive technique including ESWL, PCNL and ureteroscopy provide more safe and less mortality option for stone management. While these treatment options have become the standard of care in the adult population, which is not for children. However, PCNL may present problems in children because of the small size and mobility of the pediatric kidney, friable renal parenchyma, and the small size of the collecting system. RIRS, belongs to natural orifice transluminal endoscopy surgery, may play an important roles in pediatric urolithiasis management.
Case present:
Case 1
A 10 year-old boy with underlying disease of cerebral palsy, ventricular septal defect, bilateral renal stone and left ureter stone s/p URS-SM suffered from recurrent gross hematuria. Therefore, he was brought to our ward, where right low calyx stone around 0.8cm was diagnosed. Fr. 4.7 double-J stent was implanted one week for pre-stenting. RIRS was done and the stone was totally disintergraded by laser.
Case 2
The 13 year-old boy with recurrent urinary tract infection and right partial staghorn stone s/p PCNL twice suffered from urinary tract infection. Thus, he was refered to our ward, where right upper calyx stone around 2.1cm, right middle calyx stone 2.5cm, and right low calyx stone 1cm were diagnosed. The stone except the low calyx one which was embedded in the parenchymal tissue was almost disintegraded following two times RIRS.
Case 3
The 3 year-old girl with left low ureter stone s/p ureterolithotomy and ureteroneocystostomy, right renal stone s/p ESWL was transfered to our ward for right renal stone with hydronephrosis. There is one right UPJ stone around 1.2 cm with hydronephrosis. After one stage RIRS, the stone was almost disintegraded. Moreover, the obstructive uropathy relieved.
Conclusion:
Retrograde intrarenal surgery is a safe and effective method for the treatment of intrarenal calculi, and it achieves reasonable results with minimal complications in children.