Robot-assisted ureterolithotomy and ureteroplasty in a child with a ureteral stone

Abstract

BACKGROUND. Urolithiasis is a very common disease in all age groups. The incidence of urolithiasis in children is rapidly increasing worldwide. In this study, we describe a case of robotic ureteral stone removal and present a literature review on robotic-assisted surgeries for treating urolithiasis in children.

CLINICAL CASE DESCRIPTION. An 11-year-old boy was admitted to the children’s hospital with complaints of recurrent urinary tract infection and pain on the left side for the last year. Computed tomography revealed a stone located at the level of the proximal left ureter and the ureteral stricture located right above the stone. The child had robot-assisted ureterolithotomy and ureteroplasty. During the surgery, intraoperative contact ultrasound examination was used to locate the stone. After dissection of the ureteral wall above the stone, the calculus was grasped with a clamp and removed externally. Longitudinal ureterotomy was closed transversely with interrupted absorbable sutures. No postopreative complications were registered after the surgery. The surgery lasted for 135 minutes. Foley catheter was removed next postoperative day. The drainage catheter was removed on the 2nd postoperative day. The patient was discharged home on the 5th postoperative day. The stent was removed in 4 weeks after the surgery. Repeated ultrasound examination performed 6 months after demonstrated less dilation of the renal pelvis and ureter, and no signs of stone formation.

CONCLUSION. Our study has demonstrated that robotic-assisted surgery is a feasible, safe and effective option for treating urinary tract stones in children in some cases, such as upper urinary tract stones which are accompanied by urinary tract obstruction and require simultaneous ureterolithotomy and ureteroplasty.

Keywords

robot-assisted surgery / urolithiasis / ureterolithotomy / ureteroplasty / children

References

[1] Hwang K, Mason MD, Peters CA. Clinical practice: surgical approaches to urolithiasis in children. Eur J Pediatr. 2011;170(6):681–688. doi: 10.1007/s00431-010-1373-6

[2] Jobs K, Rakowska M, Paturej A. Urolithiasis in the pediatric population — current opinion on epidemiology, patophysiology, diagnostic evaluation and treatment. Dev Period Med. 2018;22(2):201–208. doi: 10.34763/devperiodmed.20182202.201208

[3] Samotyjek J, Jurkiewicz B, Krupa A. Surgical treatment methods of urolithiasis in the pediatric population. Dev Period Med. 2018;22(1):88–93. doi: 10.34763/devperiodmed.20182201.8893

[4] Aydogdu O, Karakose A, Celik O, Atesci YZ. Recent management of urinary stone disease in a pediatric population. World J Clin Pediatr. 2014;3(1):1–5. doi: 10.5409/wjcp.v3.i1.1

[5] Esposito C, Masieri L, Bagnara V, et al. Ureteroscopic lithotripsy for ureteral stones in children using holmium: yag laser energy: results of a multicentric survey. J Pediatr Urol. 2019;15(4):391.e1–391.e7. doi: 10.1016/j.jpurol.2019.05.004

[6] Simforoosh N, Aminsharifi A. Laparoscopic management in stone disease. Curr Opin Urol. 2013;23(2):169–174. doi: 10.1097/MOU.0b013e32835d307f

[7] Meria P, Milcent S, Desgrandchamps F, et al. Management of pelvic stones larger than 20 mm: laparoscopic transperitoneal pyelolithotomy or percutaneous nephrolithotomy? Urol Int. 2005;75(4):322–326. doi: 10.1159/000089167

[8] Casale P, Grady RW, Joyner BD, et al. Transperitoneal laparoscopic pyelolithotomy after failed percutaneous access in the pediatric patient. J Urol. 2004;172(2):680–683. doi: 10.1097/01.ju.0000129462.23322.e0

[9] Ballesteros N, Snow ZA, Moscardi PRM, et al. Robotic Management of Urolithiasis in the Pediatric Population. Front Pediatr. 2019;7:351. doi: 10.3389/fped.2019.00351

[10] Suntharasivam T, Mukherjee A, Luk A, et al. The role of robotic surgery in the management of renal tract calculi. Transl Androl Urol. 2019;8(Suppl 4):S457–S460. doi: 10.21037/tau.2019.04.06

[11] Gaur DD, Trivedi S, Prabhudesai MR, et al. Laparoscopic ureterolithotomy: technical considerations and long-term follow-up. BJU Int. 2002;89(4):339–343. doi: 10.1046/j.1464-4096.2001.01562.x

[12] Spinoit AF, Nguyen H, Subramaniam R. Role of Robotics in Children: A brave New World! Eur Urol Focus. 2017;3(2–3):172–180. doi: 10.1016/j.euf.2017.08.011

[13] Andolfi C, Kumar R, Boysen WR, Gundeti MS. Current Status of Robotic Surgery in Pediatric Urology. J Laparoendosc Adv Surg Tech A. 2019;29(2):159–166. doi: 10.1089/lap.2018.0745

[14] Jensen PH, Berg KD, Azawi NH. Robot-assisted pyeloplasty and pyelolithotomy in patients with ureteropelvic junction stenosis. Scand J Urol. 2017;51(4):323–328. doi: 10.1080/21681805.2017.1300188

[15] Atug F, Castle EP, Burgess SV, Thomas R. Concomitant management of renal calculi and pelvi-ureteric junction obstruction with robotic laparoscopic surgery. BJU Int. 2005;96(9):1365–1368. doi: 10.1111/j.1464-410X.2005.05819.x

[16] Siddiqui KM, Albala DM. Robotic-assisted surgery and treatment of urolithiasis. Int J Surg. 2016;36(Pt D):673–675. doi: 10.1016/j.ijsu.2016.11.031

[17] Madi R, Hemal A. Robotic Pyelolithotomy, Extended Pyelolithotomy, Nephrolithotomy, and Anatrophic Nephrolithotomy. J Endourol. 2018;32(S1):S73–S81. doi: 10.1089/end.2017.0718

[18] Lee RS, Passerotti CC, Cendron M, et al. Early results of robot assisted laparoscopic lithotomy in adolescents. J Urol. 2007;177(6):2306-9. doi: 10.1016/j.juro.2007.01.178

[19] Bush NC, Xu L, Brown BJ, et al. Hospitalizations for pediatric stone disease in United States, 2002–2007. J Urol. 2010;183(3):1151–1156. doi: 10.1016/j.juro.2009.11.057

[20] Assimos D, Krambeck A, Miller NL, et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART I. J Urol. 2016;196(4):1153–1160. doi: 10.1016/j.juro.2016.05.090

[21] Assimos D, Krambeck A, Miller NL, et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART II. J Urol. 2016;196(4):1161–1169. doi: 10.1016/j.juro.2016.05.091

[22] Preminger GM, Assimos DG, Lingeman JE, et al. Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol. 2005;173(6):1991–2000. doi: 10.1097/01.ju.0000161171.67806.2a

[23] Müller PF, Schlager D, Hein S, et al. Robotic stone surgery — Current state and future prospects: A systematic review. Arab J Urol. 2017;16(3):357–364. doi: 10.1016/j.aju.2017.09.004

[24] Badani KK, Hemal AK, Fumo M, et al. Robotic extended pyelolithotomy for treatment of renal calculi: a feasibility study. World J Urol. 2006;24(2):198–201. doi: 10.1007/s00345-006-0099-6

[25] Rajiv Y, Kumar A, Poonam Y. Bilateral simultaneous robot-assisted pyelolithotomy for large (> 6 cm) kidney stones: technique and review of literature. J Robot Surg. 2015;9(3):263–266. doi: 10.1007/s11701-015-0524-1

[26] Swearingen R, Sood A, Madi R, et al. Zero-fragment Nephrolithotomy: A Multi-center Evaluation of Robotic Pyelolithotomy and Nephrolithotomy for Treating Renal Stones. Eur Urol. 2017;72(6):1014–1021. doi: 10.1016/j.eururo.2016.10.021

[27] Esposito C, Masieri L, Blanc T, et al. Robot-assisted laparoscopic surgery for treatment of urinary tract stones in children: report of a multicenter international experience. Urolithiasis. 2021;49(6):575–583. doi: 10.1007/s00240-021-01271-5

[28] Olvera-Posada D, Dion M, Alenezi H, et al. Robotic Proximal Ureteropyelostomy After Unsuccessful Endourologic Management of Complicated Proximal Ureteral Stone Disease. J Endourol Case Rep. 2015;1(1):30–32. doi: 10.1089/cren.2015.29012.dop

[29] Dogra PN, Regmi SK, Singh P, et al. Lower ureteral stones revisited: expanding the horizons of robotics. Urology. 2013;82(1):95–99. doi: 10.1016/j.urology.2013.02.059

[30] Locke RA, Kwenda EP, Archer J, et al. Pediatric Robot-Assisted Laparoscopic and Ureteroscopic Ureterolithotomy and Ureteroplasty. J Endourol Case Rep. 2020;6(4):264–267. doi: 10.1089/cren.2020.0043

[31] Zheng J, Yan J, Zhou Z, et al. Concomitant treatment of ureteropelvic junction obstruction and renal calculi with robotic laparoscopic surgery and rigid nephroscopy. Urology. 2014;83(1):237–242. doi: 10.1016/j.urology.2013.08.008

[32] FDA Drug Safety Communication: FDA Approves Label Changes for Use of General Anesthetic and Sedation Drugs in Young Children. Available from: https://www.fda.gov/Drugs/DrugSafety/ucm554634.htm. Accessed: April 8, 2019.

[33] Mufarrij PW, Woods M, Shah OD, et al. Robotic dismembered pyeloplasty: a 6-year, multi-institutional experience. J Urol. 2008;180(4):1391–1396. doi: 10.1016/j.juro.2008.06.024

RIGHTS & PERMISSIONS

Kozlov Y.A., Rozhansky A.P., Sapukhin E.V., Strashinsky A.S., Ryakhina A.O., Makarochkina M.V.