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Ureteroscopy and laser stone fragmentation (URSL) for large (≥1 cm) paediatric stones: Outcomes from a university teaching hospital.
J Pediatr Urol 2017; 13(2):202.e1-202.e7JP

Abstract

INTRODUCTION

The treatment of large renal stones (≥1 cm) in paediatric patients is challenging. The usual treatment options include percutaneous nephrolithotomy (PCNL) or shockwave lithotripsy (SWL). There is a rise in the use of ureteroscopy and laser stone fragmentation (URSL) for paediatric stones; however, outcomes of treatment for large renal stones in this age group are still largely unknown.

OBJECTIVE

To investigate the outcome of URSL for large paediatric renal stones ≥1 cm treated at the present institution over the last 5 years.

METHODS

A retrospective review was performed of outcomes from the prospectively maintained stone database. Only paediatric patients undergoing ureteroscopic (rigid or flexible ureteroscopy (URS)) procedures for stones ≥1 cm were included. Patient demographics, operative details, stone burden, hospital stay, complications and stone clearance were recorded and analysed.

RESULTS

From April 2010 to June 2015, 18 paediatric patients with a mean age of 10.4 years (range 3.6-15) underwent 35 ureteroscopic procedures for large stones (≥1 cm). The stone location was in the kidney (n = 14), ureter (n = 1), and in both the kidney and ureter for the remaining three patients. Nine patients had multiple stones. There was a preceding history of PCNL in four patients, with one patient having URS combined with a PCNL. The mean follow-up was 2.7 years (range 0-5). A postoperative stent was inserted in 21 (60%) patients. The overall stone-free rate (SFR) was 89% for a mean of 1.8 procedures per patient (range 1-4) - see Summary Table below. There was an inability to access stone within a lower pole calyx in one patient, despite maximum deflection of the ureteroscope. No intra- or post-operative complications were noted, and mean hospital stay was 1.1 days (range 0-5).

DISCUSSION

Published papers in adult literature have shown that ureteroscopy and laser fragmentation (URSL) is a viable alternative to PCNL. Newer equipment and improved techniques have resulted in SFRs being comparable with PCNL. A recent systematic review reported an SFR of 91% for large adult stones (>2 cm) for a mean 1.45 procedures per patient, and an overall complication rate of 8.6%. The present study has also demonstrated excellent outcomes in the use of ureteroscopy and laser fragmentation for the management of large paediatric stones with no complications.

CONCLUSION

The results show that paediatric URSL for large stones achieves a good SFR with minimal morbidity and is a good treatment option in established endourological units.

Authors+Show Affiliations

Department of Paediatric Urology, University Hospital Southampton NHS Trust, Tremona Road, Southampton, UK. Electronic address: neilfeatherstone@doctors.org.uk.Department of Urology, University Hospital Southampton NHS Trust, Tremona Road, Southampton, UK.Department of Paediatric Urology, University Hospital Southampton NHS Trust, Tremona Road, Southampton, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28336220

Citation

Featherstone, N C., et al. "Ureteroscopy and Laser Stone Fragmentation (URSL) for Large (≥1 Cm) Paediatric Stones: Outcomes From a University Teaching Hospital." Journal of Pediatric Urology, vol. 13, no. 2, 2017, pp. 202.e1-202.e7.
Featherstone NC, Somani BK, Griffin SJ. Ureteroscopy and laser stone fragmentation (URSL) for large (≥1 cm) paediatric stones: Outcomes from a university teaching hospital. J Pediatr Urol. 2017;13(2):202.e1-202.e7.
Featherstone, N. C., Somani, B. K., & Griffin, S. J. (2017). Ureteroscopy and laser stone fragmentation (URSL) for large (≥1 cm) paediatric stones: Outcomes from a university teaching hospital. Journal of Pediatric Urology, 13(2), pp. 202.e1-202.e7. doi:10.1016/j.jpurol.2016.07.006.
Featherstone NC, Somani BK, Griffin SJ. Ureteroscopy and Laser Stone Fragmentation (URSL) for Large (≥1 Cm) Paediatric Stones: Outcomes From a University Teaching Hospital. J Pediatr Urol. 2017;13(2):202.e1-202.e7. PubMed PMID: 28336220.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ureteroscopy and laser stone fragmentation (URSL) for large (≥1 cm) paediatric stones: Outcomes from a university teaching hospital. AU - Featherstone,N C, AU - Somani,B K, AU - Griffin,S J, Y1 - 2016/08/24/ PY - 2016/02/16/received PY - 2016/07/19/accepted PY - 2016/1/1/pubmed PY - 2018/4/5/medline PY - 2017/3/25/entrez KW - Children KW - Flexible ureteroscopy KW - Kidney KW - Lasertripsy KW - Stones KW - URSL SP - 202.e1 EP - 202.e7 JF - Journal of pediatric urology JO - J Pediatr Urol VL - 13 IS - 2 N2 - INTRODUCTION: The treatment of large renal stones (≥1 cm) in paediatric patients is challenging. The usual treatment options include percutaneous nephrolithotomy (PCNL) or shockwave lithotripsy (SWL). There is a rise in the use of ureteroscopy and laser stone fragmentation (URSL) for paediatric stones; however, outcomes of treatment for large renal stones in this age group are still largely unknown. OBJECTIVE: To investigate the outcome of URSL for large paediatric renal stones ≥1 cm treated at the present institution over the last 5 years. METHODS: A retrospective review was performed of outcomes from the prospectively maintained stone database. Only paediatric patients undergoing ureteroscopic (rigid or flexible ureteroscopy (URS)) procedures for stones ≥1 cm were included. Patient demographics, operative details, stone burden, hospital stay, complications and stone clearance were recorded and analysed. RESULTS: From April 2010 to June 2015, 18 paediatric patients with a mean age of 10.4 years (range 3.6-15) underwent 35 ureteroscopic procedures for large stones (≥1 cm). The stone location was in the kidney (n = 14), ureter (n = 1), and in both the kidney and ureter for the remaining three patients. Nine patients had multiple stones. There was a preceding history of PCNL in four patients, with one patient having URS combined with a PCNL. The mean follow-up was 2.7 years (range 0-5). A postoperative stent was inserted in 21 (60%) patients. The overall stone-free rate (SFR) was 89% for a mean of 1.8 procedures per patient (range 1-4) - see Summary Table below. There was an inability to access stone within a lower pole calyx in one patient, despite maximum deflection of the ureteroscope. No intra- or post-operative complications were noted, and mean hospital stay was 1.1 days (range 0-5). DISCUSSION: Published papers in adult literature have shown that ureteroscopy and laser fragmentation (URSL) is a viable alternative to PCNL. Newer equipment and improved techniques have resulted in SFRs being comparable with PCNL. A recent systematic review reported an SFR of 91% for large adult stones (>2 cm) for a mean 1.45 procedures per patient, and an overall complication rate of 8.6%. The present study has also demonstrated excellent outcomes in the use of ureteroscopy and laser fragmentation for the management of large paediatric stones with no complications. CONCLUSION: The results show that paediatric URSL for large stones achieves a good SFR with minimal morbidity and is a good treatment option in established endourological units. SN - 1873-4898 UR - https://www.unboundmedicine.com/medline/citation/28336220/Ureteroscopy_and_laser_stone_fragmentation__URSL__for_large__≥1_cm__paediatric_stones:_Outcomes_from_a_university_teaching_hospital_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1477-5131(16)30220-0 DB - PRIME DP - Unbound Medicine ER -