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Use of the holmium:YAG laser for ureterolithotripsy in children
Hasan S Dogan1, Serdar Tekgul, Bulent Akdogan
1Faculty of Medicine, Department of Urology, Hacettepe University, Ankara, Turkey. hasedogan@yahoo.com
Insights
Rigid ureteroscopy with holmium:YAG laser lithotripsy effectively treats pediatric ureteric calculi. This safe procedure achieved a high stone-free rate in children, with improved outcomes using smaller scopes.
Area of Science:
- Pediatric Urology
- Endourology
- Nephrolithiasis Management
Background:
- Ureteric calculi in children present unique management challenges.
- Minimally invasive techniques are preferred for pediatric stone disease.
Purpose of the Study:
- To evaluate the efficacy and safety of rigid ureteroscopy and holmium:YAG laser lithotripsy for pediatric ureteric stones.
- To assess outcomes in a cohort of children treated for ureteric calculi.
Main Methods:
- Retrospective review of 35 children (15 boys, 20 girls) with ureteric calculi treated between 1997 and 2003.
- Utilized rigid ureteroscopes (7.5/8/10 F) with holmium:YAG laser lithotripsy for distal ureteral stones.
- Stenting with JJ stents or ureteral catheters was routinely performed.
Main Results:
- A stone-free rate of 82% was achieved after a single procedure, rising to 97% with repeat interventions.
- Two ureteral perforations occurred early in the series; no cases of pyelonephritis or gross hematuria were reported.
- Mean follow-up was 12 months, with a mean stone size of 8 mm.
Conclusions:
- Rigid ureteroscopy and holmium:YAG laser lithotripsy are effective and safe for pediatric ureteric stones in experienced hands.
- Smaller and flexible ureteroscopes may offer improved outcomes.
- This approach provides a viable minimally invasive option for pediatric stone disease.
Objective:
To review our experience with rigid ureteroscopy and holmium:YAG laser for treating ureteric calculi in children.
Patients And Methods:
The study included 35 children who were treated with rigid ureteroscopy for ureteric calculi between November 1997 and June 2003 (15 boys and 20 girls; mean age 6.2 years, range 1-14). The mean (range) stone size was 8 (4-15) mm and the duration of anaesthesia 46.6 (15-90) min. The stone was in the distal third of the ureter in 33 children and in the proximal third in two. We used a 7.5/8/10 F rigid ureteroscopes with 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.
Results:
Excluding the two stones pushed back, the stone-free rate after a one-stage procedure was 82% (27/33). With repeated procedures in the six (ESWL in two) remaining cases the success rate was 97% (32/33). The ureter was perforated in two patients within the first five in the series. There was no pyelonephritis or gross haematuria after surgery.
Conclusion:
Ureteroscopy and lithotripsy using the holmium:YAG laser is effective and safe for treating ureteric stones in children, in experienced hands. The results would be even better using smaller and flexible ureteroscopes.
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