Transureteral Lithotripsy of Ureteral Calculi in Children with Holmium: Yttrium Aluminium Garnet Laser (original) (raw)
Related papers
2021
Background: Endoscopic lithotripsy in pediatrics has increasingly used for the treatment of ureteral stones especially with the accessibility of smaller instruments. The safety and efficacy of Holmium: YAG laser lithotripsy makes it the intracorporeal lithotripter of choice. Aim of Study: To assess the effectives of ureteroscopy using Holmium: YAG lithotripsy in the treatment of ureteric stone in pediatrics. Patients and Methods: 30 children (20 boys and 10 girls) with ureteric stones were treated by semirigid ureteroscope using Holmium: YAG laser lithotripsy between October 2018 to May 2020. Mean patient age 3.6 years (range 8 months to 14 years). Mean stone size 12.8 mm (range 7-20 mm). Preoperative evaluation done including urinalysis, abdominal ultrasonography, plain radiography and blood investigations such as complete blood count and renal function test. Non contract abdominal CT scan used in some cases. Results: The stone free rate was 100% in one session. The mean operative ...
Journal of Pediatric Urology, 2019
Background: Holmium:YAG (Ho:YAG) laser lithotripsy has broadened the indications for ureteroscopic stone managements in adults but few evidence is currently available in the pediatric population. Objective: This paper aimed to assess the outcome of Ho:YAG laser lithotripsy during retrograde ureteroscopic management of ureteral stones in different locations in children. Study Design: The medical records of 149 patients (71 boys and 78 girls; median age 9.2 years) treated with Ho:YAG laser ureteroscopic lithotripsy in 5 international pediatric urology units over the last 5 years were retrospectively reviewed. Exclusion criteria included patients with renal calculi and/or with a history of ipsilateral stricture, renal failure, active urinary tract infection or coagulation disorder. Results: Stones were treated with dusting technique in all cases (Figure 1). The median stone size was 10.3 mm [range 5-17]. Stones were located in the distal ureter in 77 cases (51.7%), in the middle ureter in 23 (15.4%) and in the proximal ureter in 49 (32.9%). The median operative time was 29.8 minutes [range 20-95]. Intraoperative complications included 5 bleedings (3.3%) and 7 stone retropulsions (4.7%). Overall stone free rate was 97.3%. Overall postoperative complications rate was 4.0% and included 2 cases of stent migration (1.3%) (Clavien II) and 4 residual stone fragments (2.7%) that were successfully treated using the same technique (Clavien IIIb). On multivariate analysis, re-operation rate was significantly dependent on the proximal stone location and presence of residual fragments >2 mm (p=0.001). Discussion: Our study is one of the largest pediatric series among those published until now. Our series reported a shorter operative time, a higher success rate and a lower postoperative complications rate compared with previous series. A limitation of our study is that stone-free rates may be somewhat inaccurate using US and plain X-ray compared to CT; our 97.3% success rate may be overestimated since no CT scan was done postoperatively to check the stone free rate. Other limitations of our paper include its retrospective nature, the multi-institutional participation and the heterogeneous patient collective. Conclusion: The Ho:YAG laser ureteroscopic lithotripsy seems to be an excellent first line treatment for children with ureteral stones, independently from primary location and size. However, patients with proximal ureteral stones and residual fragments >2 mm reported a higher risk to require a secondary procedure to
World Journal of Urology, 2013
Objectives To evaluate the impact of age, stone size, location, radiolucency, extraction of stone fragments, size of ureteroscope and presence and degree of hydronephrosis on the efficacy and safety of holmium:YAG (Ho:YAG) laser lithotripsy in the ureteroscopic treatment of ureteral stones in children. Methods Between October 2011 and May 2013, a total of 104 patients were managed using semirigid Ho:YAG ureterolithotripsy. Patient age, stone size and site, radiolucency, use of extraction devices, degree of hydronephrosis and size of ureteroscope were compared for operative time, success and complications. Results In all, 128 URS were done with a mean age of 4.7 years. The mean stones size was 11 mm. Success rate was 81.25 %. Causes of failure were 12.5 % access failure, 1.5 % extravasation and 4.7 % stone migration. Overall complications were 23.4 %. Failure of dilatation and extravasation were detected only in children \2 years old. Extravasation was significantly higher in smaller ureters and cases with stone size [15 mm. Stone migration was significantly higher in upper ureteric stones.
Iranian Journal of Pediatrics, 2016
Background: We evaluated endoscopic treatment of ureter stones with a holmium: yttrium-aluminum-garnet laser (Ho: YAG) lithotripter and an electrokinetic lithotripter (EKL) in children. Methods: Patients with ureteral stones, admitted to the pediatric surgery department of our hospital between November 2011 and January 2015, were evaluated retrospectively. Demographic data, initial symptoms, age, sex, stone size, preoperative renal pelvis diameter, use of a jj stent, and complications were recorded. We used a 4.5 Fr semirigid ureterorenoscope with a Ho: YAG lithotripter and an EKL to treat ureteral stones. Results: In patients treated with Ho: YAG lithotripter, a total of 17 ureteroscopic procedures were performed on seven female and six male children having a mean age of 7.62 ± 4.46 years. Seven of these patients had right, five had left, and one had bilateral ureteral stones, with a mean diameter of 8.96 ± 3.52 mm. Preoperative pelvis renalis diameter was 16.22 ± 11.45 mm. A jj stent was used in all patients. Abdominal pain, hematuria, nausea-vomiting, and pollakiuria were the initial symptoms with complications such as hematuria, ureteral damage, infection, and spontaneous jj stent removal. In three cases, fragmentation was not successful and we needed a second session. In the EKL group, a total of 18 ureteroscopic procedures were performed on ten female and six male children with a mean age of 6.81 ± 3.67 years. Six of these patients had right, eight had left and two had bilateral ureteral stones, with a mean diameter of 8.26 ± 2.83 mm. Mean preoperative pelvis renalis diameter was 10.18 ± 2.66 mm. No jj stent was used in these patients. Initial symptoms were abdominal pain, hematuria, nausea-vomiting, vomiting, dysuria, and pain in the costovertebral region, while hematuria was also among the postoperative complication. In two cases, fragmentation was not successful and an extra session was needed. Conclusions: Either of Ho: YAG lithotripter or EKL are effective and can be successfully used in ureteroscopic management of pediatric ureterolithiasis. The complication rate was slightly lower when an EKL was used.
Experience with ureteroscopic holmium laser lithotripsy in children
Pediatric Surgery International, 2008
The purpose of the study was to evaluate the outcome of ureteroscopic holmium laser lithotripsy (UHLL) in children, taking into consideration different stone locations. Records of 15 children with ureteral calculi managed with UHLL were reviewed. All patients were evaluated with history, clinical, radiological and laboratory assessment prior to treatment. All patients were managed on an outpatient basis. After stone disintegration, if sizable fragments remained, they were retrieved using grasping forceps or stone basket extraction. Patient records were reviewed for age, sex, stone laterality, location, number and size, need for ureteral dilation, stenting and residual fragment extraction. Of the 15 children, 11 were female and 4 were male. Mean age was 8.5 years (age range 2-15 years). There was no significant difference in stone laterality (eight left and seven right ureteral stones). Main presenting symptoms were renal colic, hematuria and urinary tract infection or a combination of these symptoms. The 15 children harbored 15 ureteral stones (range 5-11 mm, mean 7.8 mm) and underwent 15 UHLL procedures. Ureteral dilation was performed in 14 patients using balloon dilators. Stone retrieval was done in all patients. DJ stents were placed at the conclusion of the procedure in 11 patients. Complete stone clearance was achieved at the end of the procedure in all patients (success rate 100%). No complications were encountered during or after the procedure. This study confirms the effectiveness and safety of ureteroscopy and holmium laser in the treatment of ureteral stones in children regardless of stone location.
Medical Science Monitor, 2014
Departmental sources Background: We aimed to assess the effectiveness of semi-rigid ureteroscopy and holmium laser lithotripsy in the treatment of impacted ureteral stones in children. Material/Methods: We evaluated a total of 32 children under the age of 18 years treated with ureteroscopic holmium laser lithotripsy for impacted ureteral stones between January 2005 and July 2013. Their stone-free state was defined as the absence of any residual stone on radiologic evaluation performed 4 weeks postoperatively. Complications were evaluated according to the modified Clavien classification. Result: The mean patient age was 9.5±5.1 years (range 1-18 years). Seven (21.8%) of the stones were located in the proximal ureter, 9 (28.2%) were in the mid-ureter, and 16 (50%) were in the distal ureter. The mean stone size was calculated as being 10.46±3.8 mm 2 (range 5-20). The stone-free rate was 93.75% (30/32 patients) following primary URS. Additional treatment was required for only 2 (6.25%) of the patients. After the procedure, a D-J stent was placed in all the patients. The total complication rate was 15.6% (5 patients). The 10 total complications in these 5 patients were 5 (15.6%) Grade I, 1 (3.1%) Grade II, 2 (6.25%) Grade IIIa, and 2 (6.25%) Grade IIIb. The mean follow-up period was 16.5 months (range 3-55). Conclusions: For the treatment of impacted ureteral stones in children, holmium laser lithotripsy with semi-rigid ureteroscopy, with its low retreatment requirement and acceptable complication rates, is an effective and reliable method in experienced and skilled hands as a first-choice treatment approach.
Use of the holmium:YAG laser for ureterolithotripsy in children
Bju International, 2004
routine dilatation of the ureteric orifice. For lower ureteric stones, lithotripsy was carried out with holmium:YAG laser in 29 cases, a pneumatic impactor in two and forceps extraction in two. Both stones in the proximal ureter were pushed back into the collecting system. All the ureters were stented using JJ stents in 31 and ureteric catheters in four cases. The mean postoperative follow-up was 12 (2-30) months.
Cureus
The aim of this study was to present our results regarding the feasibility and possible complications of 4.5 Fr semi-rigid ureterorenoscopy (URS) treatments in pediatric patients. Methods The files and computer records of a total of 33 pediatric patients (20 males and 13 females), who underwent URS procedures for ureteral stones > 5 mm between January 2013 and June 2017, were retrospectively reviewed. A 4.5 Fr semi-rigid ureteroscope (Ultrathin 4.5/6.5 Fr Ureterorenoscope; Richard Wolf GmbH, Knittlingen, Germany) was used for the URS procedures. For the stone-free rate evaluations, abdominopelvic ultrasound or direct radiography scans were performed one week after the surgery, and low-dose non-contrast computed tomography (CT) was performed during the first month. Results The mean age of the patients was 9.8 ± 2.8 (range 4-16) years old, and the mean ureteral stone size was 8.9 ± 1.4 (range 6-13) mm. The mean surgical duration was 45 ± 21.2 (range 30-75) minutes, and the mean hospital stay length was 1.2 (range 1-4) days. Minor complications occurred in five (15.1%) of the patients. The success rates for the first week and first month were 90.9% and 96.9%, respectively. Conclusion The endoscopic management of pediatric ureteral stones using a 4.5 Fr ureteroscope seems to be a safe and feasible treatment option with high success and low complication rates.
Efficacy and safety of endoscopic laser lithotripsy for urinary stone treatment in children
Urological Research, 2012
We reviewed our 6 years of experience with endoscopic holmium: yttrium aluminum garnet (YAG) laser lithotripsy for treatment of urinary stones in different locations in 111 children. A retrospective review was performed on endoscopic holmium: YAG laser lithotripsy procedures performed to treat stones in children between March 2006 and March 2012. In total, 120 laser lithotripsy procedures were performed to treat 131 stones in 111 children (80 males and 31 females; age range, 11 months to 16 years; median age, 6 years). Stones were located in the kidney in 48 cases (36.7 %), ureter in 52 (39.7 %), bladder in 21 (16.0 %), and urethra in 10 (7.6 %). Stone size ranged from 4 to 30 mm (mean, 12.8 mm), and anesthesia duration was 10-170 min (mean, 56 min). Forty-four ureters required balloon dilation, and 61 double J stents were inserted. Follow-up ranged from 3 to 75 months (mean, 35 months). Complete stone clearance was achieved at the end of the procedure in 102 (91.9 %) patients (age \ 7 years, 93.3 % vs. age C 7 years, 90.2 %; p [ 0.05). The success rate was 81.3 % for kidney stones (\10 mm, 90.9 % vs. C 10 mm, 78.4 %; p [ 0.05) and 100 % for the ureter, bladder, and urethral stones. Overall success rate with extracorporeal shockwave lithotripsy was 100 %. No major complications were encountered during or after the procedures. These results confirm the effectiveness and safety of holmium laser lithotripsy for treating all urinary stone locations in children of all ages.