The main treatment options for urinary tract stones have been similar as those used in the adult population and included ureterorenoscopy (URS), retrograde intra-renal surgery (RIRS), extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL). The incidence of pediatric urolithiasis is rapidly increasing worldwide. RALS was a feasible, safe and effective treatment option for pediatric urolithiasis in selected cases such as large bladder stones, bilateral kidney stones, staghorn stones or concomitant anomalies such as UPJO requiring simultaneous pyeloplasty. Three/fifteen patients (20%) with residual renal stones were successfully treated using ureterorenoscopy (Clavien 3b).
Clavien 2 complications (hematuria, infections) were recorded in 5/15 patients (33.3%). The stone-free rate was 80% following initial surgery and 100% after secondary treatment. The median operative time was 131.8 min (range 60–240). Robot-assisted cystolithotomy was performed in two patients with bladder stones. Two patients with isolated staghorn stones received robot-assisted pyelolithotomy. Eleven patients with concomitant UPJO underwent simultaneous robot-assisted pyelolithotomy and pyeloplasty in 12 kidney units. The median stone size was 10.8 mm (range 2–30) in upper tract location and 27 mm (range 21–33) into the bladder. One patient (6.6%) had bilateral multiple kidney stones. Stones were in the renal pelvis in 8/15 (53.3%), in the lower pole in 3/15 (20%), in the bladder in 2/15 (13.3%), and in multiple locations in 2/15 (13.3%).
Eleven/fifteen patients (73.3%) had concurrent uretero–pelvic junction obstruction (UPJO) and 2/15 patients (13.3%) had neurogenic bladder. The median patient age was 8.5 years (range 4–15). The medical records of 15 patients (12 boys), who underwent RALS for urolithiasis in 4 international centers of pediatric urology over a 5-year period, were retrospectively collected.
This study aimed to report a multi-institutional experience with robot-assisted laparoscopic surgery (RALS) for treatment of urinary tract stones in children.
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