Pediatric Multisystem Inflammatory Syndrome in Children as a Challenging Problem for Pediatric Surgeons in the COVID 19 Pandemic-A Case Report.

The first cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection were identified at the end of 2019 and, in the next few months, coronavirus disease (COVID-19) spread throughout the world. Initially, it was believed that this disease mainly affected elderly individuals with comorbidities, in whom respiratory failure often occurs. It was believed that children fell ill from the infection more often, although the course of infection in the vast majority of pediatric cases has been asymptomatic or mildly symptomatic. In April and May 2020, the first report of a rapidly progressing disease, similar to Kawasaki syndrome, was found in children who had been infected with SARS-CoV-2. Shortly thereafter, children with symptoms of pediatric inflammatory multisystem syndrome (PIMS-ST [temporally associated with SARS-CoV-2 infection]) began presenting to pediatric hospitals around the world. The syndrome has a mortality rate of up to 2%. Symptoms of PIMS-TS include those that may suggest the need for surgical treatment (severe abdominal pain with the presence of peritoneal symptoms, ascites, high levels of inflammatory markers, intestinal inflammation, and appendages revealed on ultrasound examination). However, there are few reports addressing surgical cases associated with this condition. The authors present a case involving an 11-year-old boy who was admitted to hospital with severe abdominal pain and underwent surgery for symptoms of peritonitis and was diagnosed with PIMS in the post-operative period. Due to the large number of illnesses caused by SARS-CoV-2 infection in recent months, the diagnosis of PIMS-TS/MISC should be considered in the differential diagnosis of acute abdominal symptoms, especially in atypical courses and interviews indicating exposure to SARS-CoV-2.

Surgical treatment methods of urolithiasis in the pediatric population.

Urolithiasis in the pediatric population represents a major challenge associated with both the diagnosis and therapy of the condition. Over the past 25 years, the incidence has increased. The average age of pediatric patients with stones is about 7-8 years and the recurrence rate is 24%-50%. More than 80% of the stones are eliminated spontaneously. The remaining ones require conservative or surgical treatment. Choosing the most appropriate treatment depends on many factors. Surgical procedures in children are the same as in adults. These include extracorporeal shockwave lithotripsy (ESWL), ureterolithotripsy (URSL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL) and laparoscopic or open surgery. ESWL is a method of choice for the treatment of stones with a diameter of ≤20 mm located in the upper urinary tract, while PCNL is used in the treatment of deposits ≥1.5 cm located in the upper pole of the kidney, deposits of ≥1.0 cm located in the lower pole of the kidney, as well as hard stones such as cystic or struvite ones. URSL/RIRS is a method for ureteral and renal stones. Open surgery is indicated in cases when anatomical anomalies coexist with urolithiasis, or when the use of PCNL or ESWL is impossible. The ideal procedure should be effective, safe and allow the complete evacuation of the stones after the 1st procedure.

Combined Use of Pyelolithotomy and Endoscopy: An Alternative Surgical Treatment for Staghorn Urolithiasis in Children.

PURPOSE: To present a combining pyelolithotomy and endoscopy, an alternative approach for treating staghorn calculi in children. MATERIALS AND METHODS: We treated 1414 children (age, 10 months to 17 years) with urolithiasis between 2009 and 2013 in the Pediatric Surgery Department and in the Pediatrics and Nephrology Department, Military Institute of Medicine in Warsaw. Most patients were treated conservatively. In 162 cases, an extracorporeal shockwave lithotripsy (SWL) procedure was needed. Surgery was only used in patients who had failed SWL. We performed minimally invasive procedures, ureterolithotripsy using semi-rigid and flexible ureterorenoscopes or percutaneous nephrolithotomy (PCNL) in 126 patients. RESULTS: In the most serious cases of staghorn or multifocal calculi, we performed a combined operation of pyelolithotomy with endoscopic removal of concrements from all calyces of the diseased kidney. In 15 out of the 18 combination treatments (83.3%), concrements were completely removed from the kidney in a single procedure. In three cases, fine concrements (5 to 6 mm) remained after the procedure, and these were candidate for SWL. In one case, a boy aged 4 years, symptoms of infection in the urinary tract occurred 2 days after the procedure. CONCLUSION: Combining pyelolithotomy with endoscopy to remove concrements clears the diseased kidney without causing parenchymal damage in one procedure. The method is safe in children, does not require blood transfusion, and helps maintain kidney function.

Ureterolithotripsy in a paediatric population: a single institution's experience.

This study presents one institution's experiences in ureterolithotripsy (URSL)--a particular endoscopic treatment modality. The incidence and prevalence of urolithiasis in the paediatric population continues to increase. However, the choice of the most appropriate treatment remains a challenging problem for paediatric surgeons. Between January 2006 and June 2013, the Department of Pediatric Surgery performed 157 URSLs. The patient population consisted of 126 children (60 girls and 66 boys) aged 10 months-17 years and having a body mass >8 kg. Dilatation of the pyelocalyceal system along with dilatation of the ureter above the concrement was present in all patients. Pneumatic, laser (Ho:YAG--pulsed laser), ultrasonic lithotripters with rigid, flexible ureteroscopes of 4.5/6 and 6.5/8 Ch were used. URSL was performed in 157 cases. During the first session, excellent results were obtained in 134 of 157 cases (85.3 %). In 15 cases (9.6 %), a second URSL was required. In five cases (3.2 %), URSL was performed a third time. A final stone-free rate of 98.1 % was obtained within the ureter. In three cases (1.9 %), complications were observed. In ten cases (6.37 %), a pigtail catheter was placed and retained in the ureter. URSL is a very good and effective endoscopic treatment for the removal of concrements localized in ureters. These concrements cause alterations in flow from the upper urinary tract in children. Because of the relatively small diameter and volume of the urinary tract in children aged <5 years, URSL in this population requires great precision, experience, and technical skill.

Ureterolithiasis in children.

The aim of our work is to present our own experience in the field of urolithiasis treatment in children using ureteroscopic lithotripsy.