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Holmium laser cystolithotripsy in children: initial experience
Prem A Ramakrishnan1, Mohammed Medhat, Younis H Al-Bulushi
1Department of Urology, Armed Forces Hospital, Muscat, Sultanate of Oman.
Insights
Transurethral Holmium: YAG (Ho: YAG) laser lithotripsy effectively treated pediatric bladder stones. This minimally invasive procedure proved safe and efficient, with no major complications or stone recurrence observed.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Laser Technology
Background:
- Pediatric bladder calculi management presents challenges.
- Current treatments include open surgery, cystolithotripsy, cystolithotomy, and shockwave lithotripsy.
- Holmium: YAG (Ho: YAG) laser lithotripsy offers a novel, minimally invasive approach.
Purpose of the Study:
- To evaluate the efficacy and safety of transurethral Ho: YAG laser lithotripsy for pediatric vesical calculi.
- To assess outcomes including stone-free rates, operative time, hospital stay, and long-term complications.
Main Methods:
- 23 children with vesical calculi (stone size ≤ 4 cm) underwent transurethral Ho: YAG laser lithotripsy.
- Calculi were fragmented using holmium laser energy via an 8F ureteroscope under video guidance.
- Post-operative evaluation included imaging and uroflowmetry at 3 and 18 months.
Main Results:
- The mean operative time was 38 minutes, with a mean hospital stay of 2.2 days.
- All children achieved stone-free status after a single session.
- No major laser-induced complications, stone recurrence, UTIs, or urethral strictures were noted at a mean follow-up of 42 months.
Conclusions:
- Transurethral Ho: YAG laser lithotripsy is an efficient and safe treatment for pediatric bladder stones.
- The procedure demonstrates excellent short-term and long-term outcomes.
- It represents a valuable minimally invasive option for managing vesical calculi in children.
Introduction:
Management of vesical calculi in children poses an interesting challenge to the urologist. The treatment options currently available include open surgery, transurethral pneumatic cystolithotripsy, percutaneous suprapubic cystolithotomy and shockwave lithotripsy (SWL). Holmium: YAG (Ho: YAG) laser cystolithotripsy represents a novel modality of treatment that is minimally invasive.
Materials And Methods:
From July 1999 to January 2003 we treated 23 children with vesical calculi using transurethral Ho: YAG laser lithotripsy. The indications for cystolithotripsy were stone size < or = 4 cm (N=19), or multiple stones with combined stone burden < or = 4 cm (N=4). The mean patient age was 7.8 (range 2-12) years and the mean stone size was 2.7 (range 0.9-4) cm. Access was obtained with an 8F ureteroscope and holmium laser energy (0.6-1.8 J/pulse at 5-12 Hz) was applied through a 550-mum. end-firing fibre under video guidance. The calculi were pulverized to tiny fragments about 2-3 mm in size. An 8F urinary catheter was placed for one night in all patients. Post-operatively the children were evaluated at 3 and 18 months with radiological imaging and uroflowmetry to confirm stone-free status and exclude urethral stricture formation.
Results:
The mean duration of the endoscopic procedure was 38 (range 19-62) minutes while the mean length of hospital stay was 2.2 (range 2-3) days. All the children were rendered stone-free following a single operative session. Laser-induced major complications were not observed in any of the children. At the mean follow-up of 42 (range 26-69) months none of the children developed stone recurrence, urinary tract infections or urethral strictures.
Conclusions:
Transurethral Ho: YAG laser lithotripsy was found to be an efficient and safe modality for the treatment of vesical calculi in children.
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