Endoscopic management of paediatric ureteric calculi by holmium:yag laser lithotripsy (original) (raw)
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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.
Ureteroscopy in the Management of Pediatric Urinary Tract Calculi
Journal of Endourology, 2005
To report our experience with ureteroscopy in the treatment of pediatric urinary tract calculi and present a review of the literature. Patients and Methods: Between 1988 and 2003, 52 ureteroscopic procedures were performed in 25 male and 10 female children aged 11 months to 15 years (mean 5.9 years). Using a semirigid 6.8F 43-cm ureteroscope and routine antibiotic prophylaxis, stones were fragmented with a pulsed-dye laser (N ؍ 14; stone size 6-15 mm with a mean of 9.6 mm), electrohydraulic lithotripsy (EHL) (N ؍ 26; stone size 3-20 mm with a mean of 8.4 mm), or a holmium laser (N ؍ 7; stone size 5-15 mm with a mean of 10 mm); removed by basket extraction (N ؍ 5; stone size 5-8 mm with a mean of 7 mm); or both. Stenting or ureteral dilatation was not performed routinely. Results: With the pulsed-dye laser, there was an overall stone-free rate of 72%. Complications consisted of one ureteral perforation and one stenosis of the intramural portion of a megaureter (14% complication rate). With EHL, the overall stone-free rate was 92%. Complications consisted of one case each of ureteral perforation and incipient urinary retention and five of mild fever (27%). With the holmium laser, the overall stonefree rate was 100%, and there were no complications. Basketing likewise produced a 100% stone-free rate, and there was one complication, a mucosal tear in a patient who also underwent pulsed-dye laser lithotripsy. Conclusion: Ureteroscopy is a safe and effective means of treating the majority of pediatric ureteral calculi, although retreatment rates are higher with multiple stones and in younger children. Dilatation of the vesicoureteral junction is usually not necessary with ureteroscopes Ͻ8F, nor is ureteral drainage required after uncomplicated ureteroscopy. The holmium laser is the most effective and safest method of fragmentation regardless of stone composition. Ureteroscopy for this indication should be performed only by an experienced endoscopist.
INTRODUCTION: Surgical management of pediatric urinary calculi evolved dramatically over the past two decades. However, with the miniaturization of equipment and with improvisation of endourologic techniques, access to the entire pediatric urinary system is possible. Ho: YAG laser provides more maneuverability during transuretereal lithotripsy (TUL) than the pneumatic system which uses a metal probe, especially when used in pediatrics urinary systems. In this study, we report our experience about treatment of pediatric ureteral stone with HO: YAG laser. METHODS: Between 2008 -2011, 41 children ≤ 12 years of age with ureteral stones were included in our study. Using K.U.B, sonography, and intravenous urogram, diagnoses were established for all patients. 6F or 8F wolf semi rigid ureteroscope was used for ureteroscopy under general anesthesia and stone fragmentation was implemented by Ho: YAG laser. For the evaluation of stone free rate, we used the following day & week confirmatory KU...
Journal of Urology, 2005
Purpose: We sought to identify whether changes in technology and local practice have improved outcomes in the minimally invasive management of pediatric stone disease. Materials and Methods: We reviewed retrospectively case notes and imaging from 1988 to 2003, noting treatment modality, stone-free rates, ancillary therapy and complications. Results: A total of 122 children (140 renal units) with a mean age of 7.7 years underwent 209 extracorporeal shock wave lithotripsy (SWL) sessions. Stone size ranged from 6 to 110 mm. Stonefree rates were 84% for cases involving stones smaller than 20 mm, and 54% for those involving stones 20 mm or greater. For complex calculi 40% of patients were stone-free and 45% required ancillary procedures, with an overall complication rate of 26%. A total of 37 children (43 renal units) with a mean age of 6.4 years underwent 46 percutaneous nephrolithotomies (PCNLs). Stone size ranged from 8 to 155 mm. The overall stone-free rate was 79%. Of these patients 34% required ancillary procedures, with a major complication rate of 6%. A total of 35 children (35 renal units) with a mean age of 5.9 years underwent 53 ureteroscopies. Holmium laser was the most effective treatment modality in this group, with a 100% stone-free rate and no complications. Conclusions: For most renal stones smaller than 20 mm SWL was the most effective primary treatment modality. There was no statistical difference between the 2 lithotriptors for stone-free or ancillary procedure rate. The stone-free rate was dependent on stone size rather than type of lithotriptor. For renal stones 20 mm or greater and staghorn calculi we switched from SWL to PCNL as primary treatment, as stone-free rates were higher and the ancillary procedure and re-treatment rates were lower with PCNL. Electrohydraulic lithotripsy and pulse dye laser were initially used to treat ureteral stones. However, with the introduction of holmium laser technology we achieved higher stone-free rates and lower complication rates. Holmium laser lithotripsy is now used as a primary treatment modality for ureteral stones.
Treatment of ureteric calculi--use of Holmium: YAG laser lithotripsy versus pneumatic lithoclast
JPMA. The Journal of the Pakistan Medical Association, 2007
To compare the efficacy of Holmium: YAG laser and pneumatic lithoclast in treating ureteric calculi. The study included total of 100 patients divided into two equal groups of laser lithotripsy (LL) and pneumatic lithoclast (PL). Study was conducted between September 2006 and February 2007. Inclusion criteria were patients with a ureteric stone of size 1-2 cm and negative urine culture. An x-ray KUB was mandatory. IVU and CT pyelogram were also done when required. Procedures were done under general anaesthesia after a single dose of pre-operative antibiotic. A 7.5 Fr semi rigid ureteroscope was used for ureteroscopy in all cases. Holmium: YAG laser with 365 microm wide probe was employed in laser group and frequency was set between 5 and 10 Hz at a power of 10 to 15 W. Swiss lithoclast with single or multiple fire technique was used accordingly in PL group. Postoperatively patients underwent radiography and helical CT as required at 4th week of follow up to asses stone clearance. The...
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
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.
Journal of Endourology, 2009
The purpose of this study was to evaluate the effectiveness of combined ureteroscopic holmium YAG lithotripsy for renal calculi associated with ipsilateral ureteral stones. Materials and Methods: Between August 2002 and March 2007, retrograde flexible ureteroscopic stone treatment was attempted in 351 cases. Indication for treatment was concurrent symptomatic ureteral stones in 63 patients (group I). Additional operative time and perioperative complication rates were compared to a group of 39 patients submitted to ureteroscopic treatment for ureteral calculi exclusively (group II). Results: Mean ureteral stone size was 8.0 Ϯ 2.6 mm and 8.1 Ϯ 3.4 mm for groups I and II, respectively. Mean operative time for group I was 67.9 Ϯ 29.5 minutes and for group 2 was 49.3 Ϯ 13.2 minutes (p Ͻ 0.001). Flexible ureteroscopic therapy for renal calculi increased 18 minutes in the mean operative time. The overall complication rate was 3.1% and 2.5% for groups I and II, respectively (p ϭ 0.87). Mean renal stone size was 10.7 Ϯ 6.4 mm, overall stone free rate in group I was 81%. However, considering only patients with renal stones smaller than 15 mm, the stone free rate was 88%. Successful treatment occurred in 81% of patients presenting lower pole stones, but only 76% of patients with multiple renal stones became stone free. As expected, stone free rate showed a significant negative correlation with renal stone size (p ϭ 0.03; r ϭ Ϫ0.36). Logistic regression model indicated an independent association of renal stones smaller than 15 mm and stone free rate (OR ϭ 13.5; p ϭ 0.01). Conclusion: Combined ureteroscopic treatment for ureteral and ipsilateral renal calculi is a safe and attractive option for patients presenting for symptomatic ureteral stone and ipsilateral renal calculi smaller than 15 mm.