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Ureteroscopic lithotripsy for ureteral stones in children using holmium: yag laser energy: results of a multicentric survey.
J Pediatr Urol. 2019 Aug; 15(4):391.e1-391.e7.JP

Abstract

BACKGROUND

Holmium:YAG (Ho:YAG) laser lithotripsy has broadened the indications for ureteroscopic stone managements in adults, but few evidence are currently available in the pediatric population.

OBJECTIVE

This article aimed to assess the outcome of Ho:YAG laser lithotripsy during retrograde ureteroscopic management of ureteral stones in different locations in children.

STUDY DESIGN

The medical records of 149 patients (71 boys and 78 girls; median age 9.2 years) treated with Ho:YAG laser ureteroscopic lithotripsy in five international pediatric urology units over the last 5 years were retrospectively reviewed. Exclusion criteria included patients with renal calculi and/or with a history of ipsilateral stricture, renal failure, active urinary tract infection, or coagulation disorder.

RESULTS

Stones were treated with dusting technique in all cases. The median stone size was 10.3 mm (range 5-17). Stones were located in the distal ureter in 77 cases (51.7%), in the middle ureter in 23 cases (15.4%), and in the proximal ureter in 49 cases (32.9%). The median operative time was 29.8 min (range 20-95). Intra-operative complications included five bleedings (3.3%) and seven stone retropulsions (4.7%). Overall stone-free rate was 97.3%. Overall postoperative complications rate was 4.0% and included two cases of stent migration (1.3%) (Clavien II) and four residual stone fragments (2.7%) that were successfully treated using the same technique (Clavien IIIb). On multivariate analysis, re-operation rate was significantly dependent on the proximal stone location and presence of residual fragments >2 mm (P = 0.001).

DISCUSSION

This study is one of the largest pediatric series among those published until now. The study series reported a shorter operative time, a higher success rate, and a lower postoperative complications rate compared with previous series. A limitation of this study is that stone-free rates may be somewhat inaccurate using ultrasonography and plain X-ray compared with computed tomography (CT); the study's 97.3% success rate may be overestimated because no CT scan was done postoperatively to check the stone-free rate. Other limitations of this article include its retrospective nature, the multi-institutional participation, and the heterogeneous patient collective.

CONCLUSION

The Ho:YAG laser ureteroscopic lithotripsy seems to be an excellent first-line treatment for children with ureteral stones, independently from primary location and size. However, patients with proximal ureteral stones and residual fragments >2 mm reported a higher risk to require a secondary procedure to become stone-free. Combination of techniques as well as appropriate endourologic tools are key points for the success of the procedure regardless of stones' size and location.

Authors+Show Affiliations

Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy. Electronic address: ciroespo@unina.it.Division of Pediatric Urology, Meyer Children Hospital, Florence, Italy.Division of Pediatric Urology, Morgagni Policlinico Hospital, Catania, Italy.Division of Pediatric Surgery, Eskisehir Osmangazi University, Eskisehir, Turkey.Division of Pediatric Urology, Medical University in Gdansk, Pomerania, Poland.Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

31182399

Citation

Esposito, C, et al. "Ureteroscopic Lithotripsy for Ureteral Stones in Children Using Holmium: Yag Laser Energy: Results of a Multicentric Survey." Journal of Pediatric Urology, vol. 15, no. 4, 2019, pp. 391.e1-391.e7.
Esposito C, Masieri L, Bagnara V, et al. Ureteroscopic lithotripsy for ureteral stones in children using holmium: yag laser energy: results of a multicentric survey. J Pediatr Urol. 2019;15(4):391.e1-391.e7.
Esposito, C., Masieri, L., Bagnara, V., Tokar, B., Golebiewski, A., & Escolino, M. (2019). Ureteroscopic lithotripsy for ureteral stones in children using holmium: yag laser energy: results of a multicentric survey. Journal of Pediatric Urology, 15(4), e1-e7. https://doi.org/10.1016/j.jpurol.2019.05.004
Esposito C, et al. Ureteroscopic Lithotripsy for Ureteral Stones in Children Using Holmium: Yag Laser Energy: Results of a Multicentric Survey. J Pediatr Urol. 2019;15(4):391.e1-391.e7. PubMed PMID: 31182399.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ureteroscopic lithotripsy for ureteral stones in children using holmium: yag laser energy: results of a multicentric survey. AU - Esposito,C, AU - Masieri,L, AU - Bagnara,V, AU - Tokar,B, AU - Golebiewski,A, AU - Escolino,M, Y1 - 2019/05/08/ PY - 2019/01/27/received PY - 2019/05/02/accepted PY - 2019/6/12/pubmed PY - 2020/6/27/medline PY - 2019/6/12/entrez KW - Children KW - Complications KW - Laser KW - Lithotripsy KW - Stones KW - Ureteroscopy SP - 391.e1 EP - 391.e7 JF - Journal of pediatric urology JO - J Pediatr Urol VL - 15 IS - 4 N2 - BACKGROUND: Holmium:YAG (Ho:YAG) laser lithotripsy has broadened the indications for ureteroscopic stone managements in adults, but few evidence are currently available in the pediatric population. OBJECTIVE: This article aimed to assess the outcome of Ho:YAG laser lithotripsy during retrograde ureteroscopic management of ureteral stones in different locations in children. STUDY DESIGN: The medical records of 149 patients (71 boys and 78 girls; median age 9.2 years) treated with Ho:YAG laser ureteroscopic lithotripsy in five international pediatric urology units over the last 5 years were retrospectively reviewed. Exclusion criteria included patients with renal calculi and/or with a history of ipsilateral stricture, renal failure, active urinary tract infection, or coagulation disorder. RESULTS: Stones were treated with dusting technique in all cases. The median stone size was 10.3 mm (range 5-17). Stones were located in the distal ureter in 77 cases (51.7%), in the middle ureter in 23 cases (15.4%), and in the proximal ureter in 49 cases (32.9%). The median operative time was 29.8 min (range 20-95). Intra-operative complications included five bleedings (3.3%) and seven stone retropulsions (4.7%). Overall stone-free rate was 97.3%. Overall postoperative complications rate was 4.0% and included two cases of stent migration (1.3%) (Clavien II) and four residual stone fragments (2.7%) that were successfully treated using the same technique (Clavien IIIb). On multivariate analysis, re-operation rate was significantly dependent on the proximal stone location and presence of residual fragments >2 mm (P = 0.001). DISCUSSION: This study is one of the largest pediatric series among those published until now. The study series reported a shorter operative time, a higher success rate, and a lower postoperative complications rate compared with previous series. A limitation of this study is that stone-free rates may be somewhat inaccurate using ultrasonography and plain X-ray compared with computed tomography (CT); the study's 97.3% success rate may be overestimated because no CT scan was done postoperatively to check the stone-free rate. Other limitations of this article include its retrospective nature, the multi-institutional participation, and the heterogeneous patient collective. CONCLUSION: The Ho:YAG laser ureteroscopic lithotripsy seems to be an excellent first-line treatment for children with ureteral stones, independently from primary location and size. However, patients with proximal ureteral stones and residual fragments >2 mm reported a higher risk to require a secondary procedure to become stone-free. Combination of techniques as well as appropriate endourologic tools are key points for the success of the procedure regardless of stones' size and location. SN - 1873-4898 UR - https://www.unboundmedicine.com/medline/citation/31182399/Ureteroscopic_lithotripsy_for_ureteral_stones_in_children_using_holmium:_yag_laser_energy:_results_of_a_multicentric_survey_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1477-5131(19)30126-3 DB - PRIME DP - Unbound Medicine ER -