Endourology involves surgeries within the urinary system through the natural channels or small holes using miniaturised telescopes.
Pediatric Endourology had its advent 3 decades back with availability of Pediatric cystoscopes and gradually with advances in technology nowadays endourogical surgeries can be offered even to newborns with urinary disorders. Pediatric urologists are trained in doing surgeries in small kids using these telescopes and in the modern era lot of the pediatric urology disorders can be managed with endoscopic surgery.
Most common type of Endourological surgeries in children:
- Uretero-renoscopy (URS)
- Semirigid URS
- Flexible URS
- Percutaneous Nephrolithotomy (PCNL)
- Percutaneous Cystolithotrity (PCCL)
Cystoscopy means examination of the inside of the urinary bladder with a telescope. These telescopes are called cystoscopes or cystourethroscopes and are inserted through the natural urinary openings. Pediatric cystoscopes are really fine caliber instruments which be used comfortably in even newborns by experienced Pediatric Urologists. The common procedures done by cystoscopy include:
- Posterior urethral valve ablation
- Anterior urethral valve ablation
- Urethral stricture dilatation
- Ureteral stenting with DJ stent
- Retrograde pyelogram
- Bladder biopsy
- Cystoscopic ablation of stones with Holmium laser
URS uses a long telescope which can be negotiated into the ureter through the natural passages via bladder and upto kidney. in kids it is advisable to place a DJ stent, 3-7 days before the URS is done as the chances of complications are more in primary URS without prior DJ stent placement. DJ stent allows the ureter to assume a larger caliber to accommodate a URS.
The uretero-renoscopes are of two types:
- Semirigid URS: have a limited flexibility, can be used in ureter alone.
- Flexible URS: can bend at 270 degrees and can reach upto kidney easily but they are not suitable for insertion in small babies.
URS surgeries in children:
- Primarily for stones stuck in ureter or pelvi-ureric junction. Once the stone in visualized, it can be tacked with Laser, forceps, lithoclast or dormia basket.
Percutaneous Nephrolithotomy (PCNL)
Percutaneous Nephrolithotomy (PCNL or Perc) is a procedure routinely employed for large kidney stones in adults. It entails making a direct puncture into the kidney through the back with a fine needle under radiological guidance. Through the needle, a guidewire is then placed and the route to the stone is made gradually bigger to about 1cm by stepwise dilatation. Finally, a telescope called nephroscope is placed and the stone is broken down into small pieces with soundwaves or Laser and removed. Adult instruments are bigger and allow removal of large pieces. Same sized instruments if used in young children can lead to kidney damage and bleeding.
For children a technique called – Mini-perc or Mini PCNL is recently being introduced. The size of the telescope is 12 French (adult is 20/24 Fr) and this can be easily used in small kids. The net cut on the back is less than 5mm and is safe for a developing small kidney. Larger fragments cannot be removed but Holmium Laser comes in handy in breaking these stones into really small pieces which are then removed or washed out. We have been routinely doing Mini-perc in children as young as 2 years of age with good results. Click here to Read More
Percutaneous Cystolithotrity (PCCL)
PCCL is an endourological surgery for managing stones in the urinary bladder or the stones impacted in the urethra which can be pushed back into bladder. It is the best, most non-invasive and painless treatment for bladder stones in children. Bladder stones are very common in children and cause pain and bleeding in urine. Bladder stones in kids are diagnosed with an ultrasound and x-ray of the pelvis. They are usually diagnosed Click here to Read More
More about kidney stones In children. Click here to Read about Kidney Stone Clinic for children