Postural therapy for renal stones in children: A Rolling Stones procedure.

INTRODUCTION: Despite many advances, the management of renal stones - especially lower caliceal stones (LCS) - remains a challenge. The gravity-dependent location of the lower calices hinders the spontaneous clearance of fragments, which can be a nidus for future growth and symptomatic recurrence. Currently, there is no standard adjunctive therapy to facilitate fragment passage. OBJECTIVES: To report the safety and effectiveness of mechanical percussion diuresis and inversion (PDI) therapy for eliminating renal stones in children. PATIENTS AND METHODS: Since November 2013, children with residual fragments (after shock wave lithotripsy or flexible ureteroscopy) or native symptomatic renal stones were prospectively included in a protocol of four PDI sessions. After giving written consent, the children drank 10 ml/kg of water 30 min before therapy. They then laid in a prone Trendelenburg position on a couch angled at 45° and received continuous 10-min mechanical percussion applied over the affected flank by a physiotherapist (Figure summary). Tolerance stone burden reduction and stone clearance were documented with ultrasound 4 weeks after the last session. RESULTS: Seventeen participants, with a median age of 10.8 years (range 18 months to 18 years), received 82 PDI sessions performed over 22 months. The median stone diameter was 5 mm (range 3-9). All children tolerated the PDI therapy well. Over a median follow-up of 11 months (range 3-18), no significant adverse effects were noted. The overall stone-free rate was 65%. Four of the six patients with residual fragment passed their fragments. The patients who did not become stone free by PDI experienced a decrease in fragment size of 57% (range 34-71). The observance rate was 100%. DISCUSSION: Many studies have demonstrated that the gravity-dependent position of the lower calyces appears to be an important factor limiting the clearance of LCS. Positioning patients with a degree of inversion in order to put the collecting system beyond the horizontal plane affected the LCS through gravitational force. Complications were rare. PDI appeared to save costs and have similar success rates as shock wave lithotripsy for native small renal stones in children. CONCLUSION: PDI is safe and effective for facilitating gravity-dependent drainage of renal stones and provides an opportunity to treat children in a quick, non-invasive, economic, painless, non-radiative and diverting fashion. This therapy is a valuable alternative in the pattern of stone management. In case of persistent fragments, it is recommend that the number of sessions be increased to six.

[Paratesticular rhabdomyosarcoma in children: a scrotal emergency]. / Le rhabdomyosarcome paratesticulaire de l'enfant : une urgence scrotale.

Paratesticular rhabdomyosarcoma is a rare and highly aggressive embryonal tumor in infancy and childhood. The tumor is intrascrotal, localized in the spermatic cord, the epididymis, or in the tunica vaginalis. Rhabdomyosarcoma represents 10% of testicular tumors of infancy. On physical examination, a painless scrotal tumefaction is observed. A surgical and pathological classification is used to group patients according to the extent of residual tumor after the initial surgical procedure: Intergroup Rhabdomyosarcoma Study classification (IRS). Multimodality therapy involving surgery, chemotherapy, and radiotherapy is necessary. Depending on the extent of disease and the staging group, the approach of treatment is different. The most important factors affecting treatment outcome are the stage, the pathological subtype of the tumor, and the age of the patient. Younger patients (<10 years) with a local tumor and with embryonal pathology have an excellent prognosis. We report the case of a 6-year-old boy admitted for a specialist consultation because of the recent appearance of a tumor in the right scrotum. On physical examination, a painless, solid, right scrotal mass was noted and the diagnosis of paratesticular rhabdomyosarcoma was made. This diagnosis can be suspected on physical and on ultrasound examinations, but only a pathological examination will confirm it. The authors discuss the therapeutic issues raised by this lesion and report one case of paratesticular rhabdomyosarcoma.