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Published on: March 6, 2018
Ureteric calculi in children: preliminary experience with holmium:YAG laser lithotripsy
S S Al-Busaidy1, A R Prem, M Medhat
1Department of Urology, Armed Forces Hospital, Muscat, Sultanate of Oman. salimalbusaidy@hotmail.com
Insights
Holmium:YAG laser lithotripsy effectively treated ureteric calculi in children, achieving a 92% stone-free rate. This safe procedure demonstrated high success across different stone locations, with minimal complications like reflux or strictures.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Laser Technology
Background:
- Ureteric calculi pose a significant challenge in pediatric patients.
- Traditional stone removal methods may have limitations in children.
Purpose of the Study:
- To evaluate the efficacy and safety of holmium:YAG laser lithotripsy for ureteric stones in pediatric patients.
- To assess the stone-free rate and identify potential complications.
Main Methods:
- Retrospective analysis of 28 ureteroscopic laser procedures on 26 children (mean age 6.5 years) with ureteric calculi.
- Utilized holmium:YAG laser with specific energy settings (0.6-1.4 J, 6-10 Hz) via a rigid ureteroscope.
- Post-procedure evaluation at 3 months using intravenous urography to confirm stone clearance and check for ureteric strictures.
Main Results:
- Achieved an overall stone-free rate of 92% (24 children).
- Success rates varied by stone location: 83% (upper), 80% (mid), and 100% (lower ureter).
- Two cases failed and were successfully managed with alternative treatments; one ureteric perforation occurred, linked to procedural difficulty and higher energy settings. Low-grade vesicoureteral reflux was detected in two patients, with no ureteric strictures observed at follow-up.
Conclusions:
- Holmium:YAG laser lithotripsy is a highly effective treatment for pediatric ureteric calculi.
- The procedure is safe, with a low incidence of significant complications.
- This technique offers a viable and successful option for managing ureteric stones in children.
Objective:
To determine the efficacy and safety of holmium:YAG laser lithotripsy in children with ureteric calculi.
Patients And Methods:
Between 1999 and 2003, 28 ureteroscopic laser procedures were carried out on 26 children (14 boys and 12 girls, mean age 6.5 years) with ureteric calculi. The mean (range) stone size was 1.21 (0.4-2.2) cm. At ureteroscopy the calculi were in the upper ureter in six (23%), mid-ureter in five (19%) and lower ureter in 15 (58%) patients. A rigid 8 F ureteroscope was used and the Ho:YAG laser energy delivered at 0.6-1.4 J and 6-10 Hz. All patients were evaluated after 3 months with intravenous urography to confirm stone clearance and to exclude ureteric stricture formation.
Results:
The overall stone-free rate was 92% (24 children) after 28 ureteroscopic procedures. Stones were completely cleared in 83%, 80% and 100% of the procedures in the upper, mid- and lower ureters, respectively. In two children the procedure failed; they were salvaged by ureterolithotomy in one and extracorporeal shockwave lithotripsy in the other. During the procedures, a ureteric perforation was caused by several factors, including a technically difficult procedure and higher laser energy. At the mean (range) follow-up of 18 (3-39) months, low grade vesico-ureteric reflux was detected in two children, and there were no ureteric strictures in any.
Conclusion:
Holmium:YAG laser lithotripsy is an efficient and safe treatment for ureteric calculi in children.
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