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Pediatric urolithiasis: 15 years of local experience with minimally invasive endourological management of pediatric calculi.
J Urol. 2005 Aug; 174(2):682-5.JU

Abstract

PURPOSE

We sought to identify whether changes in technology and local practice have improved outcomes in the minimally invasive management of pediatric stone disease.

MATERIALS AND METHODS

We reviewed retrospectively case notes and imaging from 1988 to 2003, noting treatment modality, stone-free rates, ancillary therapy and complications.

RESULTS

A total of 122 children (140 renal units) with a mean age of 7.7 years underwent 209 extracorporeal shock wave lithotripsy (SWL) sessions. Stone size ranged from 6 to 110 mm. Stone-free rates were 84% for cases involving stones smaller than 20 mm, and 54% for those involving stones 20 mm or greater. For complex calculi 40% of patients were stone-free and 45% required ancillary procedures, with an overall complication rate of 26%. A total of 37 children (43 renal units) with a mean age of 6.4 years underwent 46 percutaneous nephrolithotomies (PCNLs). Stone size ranged from 8 to 155 mm. The overall stone-free rate was 79%. Of these patients 34% required ancillary procedures, with a major complication rate of 6%. A total of 35 children (35 renal units) with a mean age of 5.9 years underwent 53 ureteroscopies. Holmium laser was the most effective treatment modality in this group, with a 100% stone-free rate and no complications.

CONCLUSIONS

For most renal stones smaller than 20 mm SWL was the most effective primary treatment modality. There was no statistical difference between the 2 lithotriptors for stone-free or ancillary procedure rate. The stone-free rate was dependent on stone size rather than type of lithotriptor. For renal stones 20 mm or greater and staghorn calculi we switched from SWL to PCNL as primary treatment, as stone-free rates were higher and the ancillary procedure and re-treatment rates were lower with PCNL. Electrohydraulic lithotripsy and pulse dye laser were initially used to treat ureteral stones. However, with the introduction of holmium laser technology we achieved higher stone-free rates and lower complication rates. Holmium laser lithotripsy is now used as a primary treatment modality for ureteral stones.

Authors+Show Affiliations

Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, Scotland, United Kingdom.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16006948

Citation

Raza, Asif, et al. "Pediatric Urolithiasis: 15 Years of Local Experience With Minimally Invasive Endourological Management of Pediatric Calculi." The Journal of Urology, vol. 174, no. 2, 2005, pp. 682-5.
Raza A, Turna B, Smith G, et al. Pediatric urolithiasis: 15 years of local experience with minimally invasive endourological management of pediatric calculi. J Urol. 2005;174(2):682-5.
Raza, A., Turna, B., Smith, G., Moussa, S., & Tolley, D. A. (2005). Pediatric urolithiasis: 15 years of local experience with minimally invasive endourological management of pediatric calculi. The Journal of Urology, 174(2), 682-5.
Raza A, et al. Pediatric Urolithiasis: 15 Years of Local Experience With Minimally Invasive Endourological Management of Pediatric Calculi. J Urol. 2005;174(2):682-5. PubMed PMID: 16006948.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pediatric urolithiasis: 15 years of local experience with minimally invasive endourological management of pediatric calculi. AU - Raza,Asif, AU - Turna,Burak, AU - Smith,Gordon, AU - Moussa,Sami, AU - Tolley,David A, PY - 2005/7/12/pubmed PY - 2005/9/17/medline PY - 2005/7/12/entrez SP - 682 EP - 5 JF - The Journal of urology JO - J. Urol. VL - 174 IS - 2 N2 - PURPOSE: We sought to identify whether changes in technology and local practice have improved outcomes in the minimally invasive management of pediatric stone disease. MATERIALS AND METHODS: We reviewed retrospectively case notes and imaging from 1988 to 2003, noting treatment modality, stone-free rates, ancillary therapy and complications. RESULTS: A total of 122 children (140 renal units) with a mean age of 7.7 years underwent 209 extracorporeal shock wave lithotripsy (SWL) sessions. Stone size ranged from 6 to 110 mm. Stone-free rates were 84% for cases involving stones smaller than 20 mm, and 54% for those involving stones 20 mm or greater. For complex calculi 40% of patients were stone-free and 45% required ancillary procedures, with an overall complication rate of 26%. A total of 37 children (43 renal units) with a mean age of 6.4 years underwent 46 percutaneous nephrolithotomies (PCNLs). Stone size ranged from 8 to 155 mm. The overall stone-free rate was 79%. Of these patients 34% required ancillary procedures, with a major complication rate of 6%. A total of 35 children (35 renal units) with a mean age of 5.9 years underwent 53 ureteroscopies. Holmium laser was the most effective treatment modality in this group, with a 100% stone-free rate and no complications. CONCLUSIONS: For most renal stones smaller than 20 mm SWL was the most effective primary treatment modality. There was no statistical difference between the 2 lithotriptors for stone-free or ancillary procedure rate. The stone-free rate was dependent on stone size rather than type of lithotriptor. For renal stones 20 mm or greater and staghorn calculi we switched from SWL to PCNL as primary treatment, as stone-free rates were higher and the ancillary procedure and re-treatment rates were lower with PCNL. Electrohydraulic lithotripsy and pulse dye laser were initially used to treat ureteral stones. However, with the introduction of holmium laser technology we achieved higher stone-free rates and lower complication rates. Holmium laser lithotripsy is now used as a primary treatment modality for ureteral stones. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/16006948/Pediatric_urolithiasis:_15_years_of_local_experience_with_minimally_invasive_endourological_management_of_pediatric_calculi_ L2 - https://www.jurology.com/doi/full/10.1097/01.ju.0000164749.32276.40?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -