Endoscopic management of paediatric ureteric calculi by holmium:yag laser lithotripsy
Purpose To determine the efficacy and safety of ureterorenoscopic Holmium:YAG lithotripsy for ureteric stone in children. Material and Methods Records of 186 children with ureteral calculi managed with ureterorenoscopic Holmium:YAG lithotripsy were reviewed between July 2005 and December 2007. Patient records were reviewed for age, sex, stone laterality, location, number and size, need for ureteral stenting and complications in perioperative period and follow up. Paediatric cystoscope(miniscope) size 6/7.6 ch, ureterorenoscopes sizes 6/7.5 ch and 7.8/9 ch were used according to the size of patient and site of stone. Results Of the 186 children, 71 were female and 115 were male. Mean age was 6.1 years (age range 9months-14 years). There was no significant difference in stone laterality (eighty four left, ninety four right and eight bilateral ureteral stones). Main presenting symptoms were renal colic, hematuria and urinary tract infection or a combination of these symptoms. DJ stents were placed at the conclusion of the procedure in 54 patients while ureteral catheter was retained in rest of the cases for 24 to 48 hours. The procedure was carried in the same session for bilateral stones in eight patients. Additional procedure include PCNL in 12 and cystolithoclast in 5 cases for associated renal and bladder calculi respectively. Complete stone clearance was achieved at the end of the treatment in all patients (success rate 100%). Complications encountered during the procedure include extravasation of irrigant in 5 patients, required ultrasound guided placement of drain and per cutaneous nephrostomy in 2 patients for transient obstructive hydronephrosis. Other complications include mild haemeturia and urinary tract infection. Conclusions This study confirms the effectiveness and safety of ureterorenoscopy and holmium laser in the treatment of ureteral stones in children regardless of stone location.