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Retrograde ureteroscopy for distal ureteric stone removal in children
Mauro De Dominicis1, Ennio Matarazzo, Nicola Capozza
1Division of Paediatric Urology, Department of Nephrology and Urology, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy.
Insights
Ureteroscopy plus intracorporeal lithotripsy (ULT) is more effective than extracorporeal shock wave lithotripsy (ESWL) for treating pediatric distal ureteric stones. ULT offers a higher stone-free rate and better efficiency quotient in children.
Area of Science:
- Pediatric Urology
- Endourology
- Nephrolithiasis Treatment
Background:
- Distal ureteric calculi in children are often treated with extracorporeal shock wave lithotripsy (ESWL) as a first-line option, mirroring adult practice.
- However, there is a lack of consensus regarding the optimal treatment method for pediatric distal ureteric stones.
- This study aims to clarify the most effective and safe approach for this patient population.
Purpose of the Study:
- To compare the efficacy and safety of ureteroscopy plus intracorporeal lithotripsy (ULT) versus extracorporeal shock wave lithotripsy (ESWL).
- To evaluate treatment success, effectiveness quotient, complication rates, and hospitalization duration for both procedures in children.
- To determine the preferred treatment modality for distal ureteric calculi in pediatric patients.
Main Methods:
- A randomized controlled trial involving 31 children (mean age 7.2 years) with distal ureteric stones from July 2002 to July 2003.
- Patients were assigned to either ULT (using a 7.5 F ureteroscope with ballistic lithotripter or holmium-YAG laser) or ESWL (using a second-generation lithotripter).
- Outcomes including stone-free rates, effectiveness quotient, complications, and hospitalization were assessed and statistically analyzed.
Main Results:
- The total stone-free rate after initial treatment was significantly higher for ULT (16/17) compared to ESWL (6/14) (P = 0.004).
- Five patients with failed ESWL treatments achieved successful stone clearance with subsequent ULT.
- No significant differences were observed in complication rates or hospitalization duration between the two groups; general anesthesia was required for both in children under 12.
Conclusions:
- Ureteroscopy plus intracorporeal lithotripsy (ULT) is recommended as the primary treatment for distal ureteric calculi in children.
- The study demonstrates that ULT, utilizing small ureteroscopes, provides a safe and highly effective method for stone removal in this age group.
- ULT offers a superior stone-free rate and efficiency compared to ESWL for pediatric distal ureteric stones.
Objective:
To compare the efficacy and safety of ureteroscopy plus intracorporeal lithotripsy (ULT) with extracorporeal shock wave lithotripsy (ESWL) for treating distal ureteric calculi in childhood, as such stones are commonly treated by ESWL as the first option in adults but there is no agreement on the method of treating them in children.
Patients And Methods:
From July 2002 to July 2003, children presenting with ureteric stones were consecutively randomized for treatment using ULT or ESWL. The two groups were matched for age, sex and stone position in the distal ureter. A 7.5 F ureteroscope combined with a ballistic lithotripter or holmium-YAG laser was used for ULT. ESWL was administered using a second-generation lithotripter. The success rate, effectiveness quotient, complication rate and hospitalization were evaluated and compared using Student's t-test (chi-square) and Fisher's exact test as appropriate. In all, 31 patients (21 girls and 10 boys, mean age 7.2 years, range 2-17) were treated, by ULT in 17 (12 girls and five boys) and ESWL as a primary procedure in 14 (five boys and nine girls).
Results:
After one ULT, all the girls and four boys, and after ESWL, four girls and two boys, were rendered stone-free at the first treatment. The total stone-free rate was 16 of 17 for ULT and six of 14 for ESWL (P = 0.004). Eight patients had a second ESWL and three then became stone-free. The five patients in whom both ESWL treatments failed had a successful ULT. There was no significant difference between the groups in complication rate and hospitalization. General anaesthesia was required in all patients <12 years old treated by ULT or ESWL. The calculated efficiency quotient for treating distal ureteric calculi was significantly lower for ESWL than ULT (P < 0.05).
Conclusions:
ULT should be recommended as the treatment of choice for distal ureteric calculi in children; using small ureteroscopes the target stone was treated safely and effectively.
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