Percutaneous approach in pediatric urological pathology
DOI:
https://doi.org/10.48193/85xcvk36Keywords:
Percutaneous approach, Pediatric renal litiasis, Recurrent pyeloureteral junction obstruction, EndopyelotomyAbstract
Introduction: The safety of the percutaneous approach has made it possible to improve instrumentation and progressively decrease the caliber of the instruments. The objective of this study is to present our experience in the use of the percutaneous approach for the treatment of recurrent lithiasis and recurrent pyeloureteral stenosis in children.
Material and methods: A retrospective review was carried out in our center, including all the patients who underwent a percutaneous approach between the years 2007-2020. In the case of patients with recurrent pyeloureteral junction obstruction (PUJO) a high-pressure balloon is placed retrogradely at the pyeloureteral junction. Next, the kidney was percutaneously approached by ultrasound and fluoroscopic control. Percutaneous endopyelotomy or lithotripsy was accomplished using monopolar hook electrocautery or holmium laser fiber. All patients had a double J catheter for 3-4 weeks. Nephrostomy was necessary in 9 of 24 patients.
Results: A total of 24 patients were included. Two groups were established: group 1 (n=15) had recurrent PUJO, and group 2 with 7 patients had kidney stones. Two more patients are added who do not belong to the groups described, a 16-year-old patient with hydrocalyx and a 13-year-old patient with renal cyst. The median age was 5 years (2-16). The most frequent complication was hematuria, followed by urinary tract infection in 3 patients. The median surgical time in group 1 was 60 minutes (35-90), in group 2 was 100 minutes (75-180). The mean time of admission in both groups was 3 days (2-7). The mean follow-up time in group 1 was 6 years (2-13), in group 2 it was 7 years (5-8).
Conclusions: Percutaneous approach is a safe and very practical technique in the management of lithiasis and recurrent PUJO in children. The miniaturization of the instruments makes it possible to expand the indications and reduce morbidity in our patients.
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