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    Are small residual stone fragments really insignificant in children?
    (W B Saunders Co-Elsevier Inc, 2013) Dincel, Nida; Resorlu, Berkan; Unsal, Ali; Tepeler, Abdulkadir; Silay, Mesrur Selcuk; Armagan, Abdullah; Diri, Akif
    Objectives: To assess the significance of asymptomatic residual stone fragments of less than 4 mm (clinically insignificant residual fragments [CIRFs]) after shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL), and retrograde intrarenal surgery (RIRS) in children. Patients and Methods: Eighty-five children were followed up for 6 to 50 months (median 22). Outcomes measured were fragment re-growth, stone events (emergency department visits, hospitalization, or additional interventions) and spontaneous fragment passage. Results: During follow-up, 22 children (25.8%) passed residual fragments spontaneously. Highest spontaneous passage rate was found for renal pelvis stones and the lowest for the lower pole stones (57.1% vs. 16.1%; p<0.001). When the number of the fragments increased, the chance of the spontaneous passage decreased (30% vs 20%; p<0.05). Symptomatic episodes including renal colic, hematuria, or urinary tract infection were documented in 34 (40%) patients, and re-growth of fragments was observed in 18 (21.2%). Stone size had no significant effect on spontaneous passage (p=0.079), stone growth (p=0.528), and symptomatic episodes (p=0.402). Twenty-five patients (29.4%) required secondary intervention for stone re-growth or stone related events and the remaining 20 patients (23.5%) needed medical treatment for bothersome symptoms or complications. Conclusions: Our results suggest that 40% of children with CIRFs will become symptomatic and 20% will develop stone re-growth over the following 6 months. Only one fifth of the fragments will pass spontaneously without any complications. Therefore, the use of the term CIRF is not appropriate for postoperative residual fragments in children. (c) 2013 Elsevier Inc. All rights reserved.
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    ENDOUROLOGIC MANAGEMENT OF PEDIATRIC FORGOTTEN STENTS: 22 PATIENTS FROM 4 CLINICS
    (Mary Ann Liebert, Inc, 2012) Sancaktutar, Ahmet Ali; Adanur, Senol; Resorlu, Berkan; Tepeler, Abdulkadir; Ziypak, Tevfik; Atar, Murat; Bozkurt, Yasar
    [Abstract Not Available]
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    The Forgotten Ureteral Stent in Children: From Diagnosis to Treatment
    (Elsevier Science Inc, 2013) Sancaktutar, Ahmet Ali; Adanur, Senol; Resorlu, Berkan; Tepeler, Abdulkadir; Ziypak, Tevfik; Soylemez, Haluk; Atar, Murat
    Purpose: We conducted a multicenter pediatric study of ureteral stents unintentionally left in situ. Materials and Methods: A total of 22 patients with encrusted Double-J (R) ureteral stents unintentionally left in situ were treated at 4 centers between January 2007 and March 2012. Stone burdens were estimated using plain radiography and computerized tomography. Treatment decision was made based on clinical and radiological findings or stone burden. Results: Nine girls and 13 boys with a mean age of 9.5 years (range 2 to 16) were analyzed. Mean indwelling time of ureteral stent was 21.7 months (range 6 to 60). Stents were inserted for the indication of urolithiasis (17 patients) and reconstructive urological intervention (5). In 2 patients stents had been placed bilaterally. Mean stent stone burden was 184 mm(2) on plain radiography and 247 mm(2) on computerized tomography, a difference that was statistically significant (p = 0.002). Shock wave lithotripsy was done in 6 cases. Endoscopic procedures were performed in all patients, including ureteroscopy in 8, simple stent removal in 7, endoscopic cystolithotripsy in 6, percutaneous nephrolithotomy in 5, retrograde intrarenal surgery in 3 and percutaneous cystolithotripsy in 2. Surgical removal of each stent required a mean of 1.5 interventions and a mean hospital stay of 4.4 days. Conclusions: At experienced centers combined endourological techniques can achieve successful and safe management of forgotten stents even in the pediatric age group. Thus, routine preprocedural tomography is a must in children with forgotten ureteral stents.
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    Percutaneous nephrolithotomy for the treatment of radiolucent renal stones in children: is it different opaque stone treatment?
    (Springer, 2014) Adanur, Senol; Ziypak, Tevfik; Sancaktutar, Ahmet Ali; Tepeler, Abdulkadir; Resorlu, Berkan; Soylemez, Haluk; Daggulli, Mansur
    We aimed to evaluate the effectiveness of percutaneous nephrolithotomy (PNL), stone-free rates, and related complications in children with radiolucent renal stones. A total of 56 patients aged < 16 years from four institutions were enrolled in our study. Asymptomatic, clinically insignificant residual fragments measuring < 4 mm or a complete stone-free status was accepted as the criterion for clinical success. Complications were evaluated according to the modified Clavien classification. The mean age of the patients was 7.8 +/- A 4.5 years. The mean stone size was calculated as 24.07 +/- A 10.4 mm. The median operative and fluoroscopy times were 53.2 min (15-170 min) and 172.4 s (5-520 s), respectively. The success rate after PNL monotherapy was 87.4 %; the total success rate with shock wave lithotripsy used as an auxillary treatment method was detected as 94.6 %. The total complication rate was 19.6 % (11 patients). No adjacent organ injury was observed. All of the complications that occurred were minor according to the Clavien classification (Clavien Grades I-II). PNL can be applied to radiolucent pediatric renal stones in children with similar success, and complication rates as noted for radiopaque stones.