title: Minimal access surgery in the management of pediatric urolithiasis.
abstract: OBJECTIVE
  In contrast to adult patients, a relatively large number of open surgical procedures are still needed in the treatment of urolithiasis in children. Since almost all open surgical techniques may be reproduced by minimal access surgery (MAS), there is a rationale to apply the latter in the management of pediatric urolithiasis. Our study aimed to assess the feasibility and outcome of MAS in the treatment of pediatric urinary calculi.
  
  
  METHODS
  The charts of patients with urolithiasis submitted to MAS between 1994 and 2007 were retrospectively reviewed. The inclusion criteria were contraindication for and failure of lithotripsy or endourology techniques. Demographic data, lithiasis characterization (location, dimension, composition), predisposing factors (anatomic or metabolic) and surgical approach (technique and outcome) were evaluated.
  
  
  RESULTS
  Fifteen consecutive patients (eight girls, seven boys) with a median age of 108 months (range: 10-297) were elected for MAS. Eleven (73%) children had associated urogenital malformations and three (20%) presented metabolic abnormalities. A total of 17 procedures were performed laparoscopically: three nephrolithotomies (one transperitoneal, two by retroperitoneoscopy), four pyelolithotomies (retro), three ureterolithotomies (trans) and seven cystolithotomies (suprapubic approach). Five patients underwent concomitant correction of urological anomalies (three calyceal diverticula, one obstructive megaureter, one ureteropelvic junction obstruction). Complete removal of calculi was accomplished in 14 (82%) procedures. There were two perioperative complications (one intraperitoneal vesical perforation and one perivesical urinoma). At a median follow up of 4 years (range: 1 month to 11 years), four patients have developed recurrence.
  
  
  CONCLUSIONS
  Minimal access surgery is an effective and safe approach for urolithiasis in children who are not candidates for minimally invasive modalities. Individualized application of different techniques may solve virtually all cases. In selected cases, the role of MAS as first-choice therapy deserves consideration.
authors.affiliation: Department of Pediatric Surgery, Faculty of Medicine of Porto, Hospital S João, Porto, Portugal. catarina.fragoso@gmail.com
authors.forename: Ana Catarina
authors.initials: AC
authors.lastname: Fragoso
authors.forename: Jean-Stéphane
authors.initials: JS
authors.lastname: Valla
authors.forename: Henry
authors.initials: H
authors.lastname: Steyaert
authors.forename: Pierre
authors.initials: P
authors.lastname: Arnaud
authors.forename: Ciro
authors.initials: C
authors.lastname: Esposito
authors.forename: José
authors.initials: J
authors.lastname: Estevão-Costa
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014567:Urography; D052878:Urolithiasis / Q000175:diagnosis / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*