Rigid and flexible ureteroscopy (URS/RIRS) management of paediatric urolithiasis in a not endemic country
Introduction: In the last years due to miniaturization of endoscopic instruments and percutaneous surgery, endourology has become very popular in paediatric urinary stone managment. We reported our single-centre experience in retrograde endoscopic procedures in children. Results and complications of URS/RIRS are discussed.
Materials and methods: We retrospectively reviewed our experience in patients ≤ 16 years old affected by urinary stones who underwent URS/RIRS procedures performed by two surgeons with expertise in endourology. A total of 30 renal Units (RUs) underwent endoscopic procedures (URS, RIRS or both). Surgical complications according to the ClavienDindo’s classification and stone-free rate were evaluated at 3 months follow-up. Success of URS was defined as stone-free status after single procedure while RIRS success rate was considered as presence of residual stone fragments smaller than 4 mm at first procedure.
Results: The mean age of our patients was 8 years, range 2- 16 years. A total of 30 renal units (RUs) underwent 40 endourological procedures (23 URS and 17 RIRS; 10 children underwent both procedures at the same time). 17/30 (56.6%) RUs were pre-stented before surgery. The stone-free status was achieved in 23/30 renal units treated, with a 76.6% success rate. The remaining 7 patients had residual stones greater than 4 mm and underwent further treatments. After a second surgery the stone-free rate turned out to be 93.3% (28/30 renal units).
Conclusions: Rigid and flexible ureteroscopy (URS/RIRS) is a reliable technique for treatment of < 2 cm urinary stones in paediatric age group. It shows low rate of major complications and promising results in terms of stone-free rate.
Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015; 136:E359-86. DOI: https://doi.org/10.1002/ijc.29210
Freedland SJ, Humphreys EB, Mangold L, et al. Death in patients with recurrent prostate cancer after radical prostatectomy: prostatespecific antigen doubling time subgroups and their associated contributions to all-cause mortality. J Clin Oncol. 2007; 25:1765-71. DOI: https://doi.org/10.1200/JCO.2006.08.0572
Toussi A, Stewart-Merrill SB, Boorjian SA, et al. Standardizing the definition of biochemical recurrence after radical prostatectomy- What prostate specific antigen cut point best predicts a durable increase and subsequent systemic progression? J Urol. 2016;195:1754-9. DOI: https://doi.org/10.1016/j.juro.2015.12.075
Roach M, Hanks G, Thames H Jr, et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference Int J Radiat Oncol Biol; Phys. 2006; 65:965-74. DOI: https://doi.org/10.1016/j.ijrobp.2006.04.029
Van den Broeck, van den Bergh R, Briers E, et al. Biochemical recurrence in prostate cancer: the European Association of Urology Prostate Cancer Guidelines Panel Recommendations Eur Urol Focus. 2020; 6:231-234. DOI: https://doi.org/10.1016/j.euf.2019.06.004
Eissa A, Elsherbiny A, Coelho RF, et al. The role of 68Ga-PSMA PET/CT scan in biochemical recurrence after primary treatment for prostate cancer: a systematic review of the literature. Minerva Urol Nefrol. 2018; 70:462-478. DOI: https://doi.org/10.23736/S0393-2249.18.03081-3
Albisinni S, Artigas C, Aoun F, et al. Clinical impact of 68 Gaprostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in patients with prostate cancer with rising prostate-specific antigen after treatment with curative intent: preliminary analysis of a multidisciplinary approach. BJU Int. 2017; 120:197-203. DOI: https://doi.org/10.1111/bju.13739
Emmett L, van Leeuwen PJ, Nandurkar R, et al. Treatment Outcomes from 68Ga-PSMA PET/CT-Informed Salvage Radiation Treatment in Men with Rising PSA After Radical Prostatectomy: Prognostic Value of a Negative PSMA PET. J Nucl Med. 2017;58:1972-6. DOI: https://doi.org/10.2967/jnumed.117.196683
Afshar-Oromieh A, Holland-Letz T, Giesel FL, et al. Diagnostic performance of 68Ga-PSMA-11 (HBED-CC) PET/CT in patients with recurrent prostate cancer: evaluation in 1007 patients. Eur J Nucl Med Mol Imaging. 2017; 44:1258-68
Perera M, Papa N, Christidis D, et al. Sensitivity, specificity, and predictors of positive 68Ga-prostate-specific membrane antigen positron emission tomography in advanced prostate cancer: a systematic review and meta-analysis Eur Urol 2016; 70:926-37.
Meredith G, Wong D, Yaxley J, et al. The use of 68 G a-PSMA PET CT in men with biochemical recurrence after definitive treatment of acinar prostate cancer. BJU Int. 2016; 118:49-55. DOI: https://doi.org/10.1111/bju.13616
Mottet N, van den Bergh R, Briers E, et al. EAU - EANM - ESTRO - ESUR - SIOG Guidelines on Prostate Cancer 2020.
Aboagye EO, Kraeber-Bodéré F. Highlights lecture EANM 2016:“Embracing molecular imaging and multi-modal imaging: a smart move for nuclear medicine towards personalized medicine”. Eur J Nucl Med Mol Imaging. 2017; 44:1559-1574. DOI: https://doi.org/10.1007/s00259-017-3704-6
Perera M, Papa N, Roberts M, et al. Gallium-68 Prostate-specific Membrane Antigen Positron Emission Tomography in Advanced Prostate Cancer-Updated Diagnostic Utility, Sensitivity, Specificity, and Distribution of Prostate-specific Membrane Antigenavid Lesions: A Systematic Review and Meta-analysis. Eur Urol. 2020;77:403-417. DOI: https://doi.org/10.1016/j.eururo.2019.01.049
Budaus L, Leyh-Bannurah SM, Salomon G, et al. Initial experience of 68Ga-PSMA PET/CT imaging in high risk prostate cancer patients prior to radical prostatectomy. Eur Urol. 2016; 69:393-6. DOI: https://doi.org/10.1016/j.eururo.2015.06.010
Demirci E, Kabasakal L, Sahin OE, et al. Can SUVmax values of Ga-68-PSMA PET/CT scan predict the clinically significant prostate cancer? Nucl Med Commun. 2019; 40:86-91. DOI: https://doi.org/10.1097/MNM.0000000000000942
Sanli Y, Kuyumcu S, Sanli O, et al. Relationships between serum PSA levels, Gleason scores and results of 68Ga-PSMAPET/CT in patients with recurrent prostate cancer. Ann Nucl Med. 2017; 31:709-717. DOI: https://doi.org/10.1007/s12149-017-1207-y
Perera M, Papa N, Christidis D, et al. Sensitivity, specificity, and predictors of positive (68) Ga-prostate-specific membrane antigen positron emission tomography in advanced prostate cancer: a systematic review and meta-analysis. Eur Urol. 2016; 70:926-937. DOI: https://doi.org/10.1016/j.eururo.2016.06.021
Eder M, Neels O, Müller M, et al. Novel preclinical and radiopharmaceutical aspects of [(68)Ga]Ga-PSMA-HBED-CC: a new PET tracer for imaging of prostate cancer. Pharmaceuticals. 2014;7:779-96. DOI: https://doi.org/10.3390/ph7070779
Heidenreich A, Bastian PJ, Bellmunt J, et al. European Association of Urology. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol. 2014; 65:124-137. DOI: https://doi.org/10.1016/j.eururo.2013.09.046
Eiber M, Maurer T, Souvatzoglou M, et al. Evaluation of Hybrid 68Ga-PSMA Ligand PET/CT in 248 Patients with Biochemical Recurrence After Radical Prostatectomy. J Nucl Med. 2015; 56:668-74. DOI: https://doi.org/10.2967/jnumed.115.154153
Afshar-Oromieh A, Holland-Letz T, Giesel FL, et al. Diagnostic performance of (68)Ga-PSMA-11 (HBED-CC) PET/CT in patients with recurrent prostate cancer: evaluation in 1007 patients. Eur J Nucl Med Mol Imaging. 2017;44:1258-68. DOI: https://doi.org/10.1007/s00259-017-3711-7
Han S, Woo S, Kim YJ, Suh CH. Impact of 68Ga-PSMA PET on the management of patients with prostate cancer: a systematic review and meta-analysis. Eur Urol. 2018; 74:179-90. DOI: https://doi.org/10.1016/j.eururo.2018.03.030
Murphy DG, Sweeney CJ, Tombal B.Gotta catch ‘em al,” or do we? Pokemet approach to metastatic prostate cancer Eur Urol. 2017; 72:1-3. DOI: https://doi.org/10.1016/j.eururo.2017.02.036
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