Surgeons at Southampton’s university hospitals are using a less invasive technique to remove large kidney stones in children which reduces complications and speeds up recovery.
Bhaskar Somani, a consultant urological surgeon, and colleague Stephen Griffin, who specialises in paediatric urology, have introduced ureteroscopy and laser stone fragmentation (URSL) routinely for young patients with stones larger than 1cm at Southampton Children’s Hospital.
Kidney – or renal – stones develop when crystals of salt accumulate into stone-like lumps which are not flushed out of the body. The condition affects mainly adults but incidence among children is increasing worldwide.
URSL, which involves the combination of a viewing instrument – a ureteroscope – inserted in the kidney via the bladder to visualise the stones and a laser beam to break them up, is already used in Southampton to treat adults with stones larger than 2cm with a stone-free success rate of 85% to 90%.
However, the gold standard treatment for larger stones in both adults and children remains percutaneous nephrolithotomy (PCNL), where surgeons create a small incision in the back and remove stones via a tube.
PCNL in children has a success rate of between 77% and 95% but normally requires a hospital stay of two to three days and the need for a blood transfusion in 5% to 10% of cases.
In a study published in the Journal of Pediatric Urology, Mr Somani and Mr Griffin reported a URSL stone-free success rate of 89% among 18 patients aged between four to 15 years who underwent 35 procedures with no bleeding or any other complications and a hospital stay of only one day.
“This data demonstrates URSL is a viable alternative to PCNL for children with large kidney stones with no complications – including bleeding – and a much shorter hospital stay,” explained Mr Somani, who is also an associate professor of urology at the University of Southampton.
“Although the rate of stone clearance for both procedures is similar, any opportunity to expand the use of less invasive techniques, particularly among children, should be explored fully.”
Mr Somani said he and colleague Mr Griffin have now performed more than 75 URSL procedures on children – one of the largest audited series in the UK – with minor complications seen in just three cases in this series.
Posted on Tuesday 7 March 2017