The Miniaturization of Instruments and Laser Lithotripsy have Improved Urolithiasis Treatment without Requiring Fluoroscopic Control in Preschool Children
Abstract
Aim: To present the outcomes of retrograde intrarenal surgery (RIRS) and laser lithotripsy for the treatment of calculi of preschool age children.
Patients and Methods: The records of 28 patients ≤6 years old who underwent endoscopic procedures for treatment of stones at the our hospital from 2013 to 2016 were reviewed retrospectively. In the treatment of renal and upper ureteral stones, laser lithotripsy was used with flexible ureterorenoscope (URS) without ureteral dilatation. The information recorded included patient demographics, stone size and location, operative technique and postoperative outcomes.
Results: A total of 32 lithotripsy procedures to treat 34 stones were performed in 28 children 18 ( 64%) males and 10 (36 %) females; 22 (78.5%) single and 6(21.5%) multiple stones; median age, 45,8±9,36 months (10-72). Stones were located in the kidney in 21 cases (75%), the upper ureter in 7(25%). Mean stone size was 12,07-+1,74(9-15) mm. Four (14.2%) of these patients also had bladder stone accompanying it. The stones of these patients were also fragmented using laser with flexible URS. Anesthesia duration was 26-105 min (mean, 59,64±22,39). In fourteen patients with narrow ureteral orifices urethral JJ stents were placed firstly and flexible URS were done easily after 2 weeks. We did not use fluoroscopy; thus radiation free treatment was reached all patients. Follow-up ranged from 2 months to 3 years (mean, 24 months). Complete stone clearance was achieved at the end of the procedure in 26 (92.8%) patients. No major complications were encountered during or after the procedure, although 2 minor complications ( 7.1%) occurred. The mean duration of hospitalization was 2,21±0,87 days (range, 1-4 days). Recurrence of urolithiasis was a long-term complication in two patients; These cases were subsequently treated smilarly with flexible URS. No other long-term complications were revealed by ultrasonography.
Conclusions: Our results suggest that flexible URS is a safe and effective minimally invasive treatment modality for renal stones in preschool children.
References
References
Urinary Stone Disease. Tekgul S, Dogan HS, Hoebeke P, et al. European Association of Paediatric Urology Guidelines, 2016 Edition, 58-65.
Dogan HS, Onal B, Satar N, Bilen CY, Güneş A, Ozden E, et al. Factors affecting complication rates of ureteroscopic lithotripsy in children: results of multiinstitutional retrospective analysis by Pediatric Stone Disease Study Group of Turkish Pediatric Urology Society. J Urol 2011; 186:1035-40.
Unsal A, Resorlu B. Retrograde intrarenal surgery in infants and preschool-age children. J Pediatr Surg 2011; 46: 2195-9.
Dave S, Khoury AE, Braga L, Farhat WA. Single-institutional study on role of ureteroscopy and retrograde intrarenal surgery in treatment of pediatric renal calculi. Urology 2008;72: 1018-21.
Unsal A, Resorlu B, Kara C, Bozkurt OF, Ozyuvali E. Safety and efficacy of percutaneous nephrolithotomy in infants, preschool age, and older children with different size of instruments. Urology 2010; 76: 247- 52.
Uygun I, Okur MH, Aydogdu B, Arayici Y, Isler B, Otcu S. Efficacy and safety of endoscopic laser lithotripsy for urinary stone treatment in children. Urol Res 2012;40(6):751-5
Ritchey M, Patterson DE, Kelalis PP, Segura JW. A case of pediatric ureteroscopic lasertripsy. J Urol 1988;139:1272-4.
Shepherd P, Thomas R, Harmon EP. Urolithiasis in children: innovations in management. J Urol 1988;140:790-2.
Çıtamak B, Altan M, Bozacı AC, Koni A, Doğan HS, Bilen CY, et al. Percutaneous Nephrolithotomy in Children: 17 Years of Experience. J Urol 2016; 195(4P1):1082-7.
Erkurt B, Caskurlu T, Atis G, Gurbuz C, Arikan O, Pelit ES, Altay B, et al. Treatment of renal stones with flexible ureteroscopy in preschool age children. Urolithiasis 2014;42: 241-5.
Turkyilmaz Z, Sonmez K, Karabulut R, Polat F, Yesil S, Eryilmaz S, et al Should Flexible Ureterorenoscopy be the First-line Treatment Option for Renal Calculi? Gazi Medical Journal 2017; 28: 204-5.
