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Interest of URS-L in the Treatment of Ureterolithiasis in Preschool Children.
Front Pediatr 2019; 7:324FP

Abstract

Urolithiasis can affect all children even preschool ones. Diagnostic difficulties in the youngest children are due to the problems in locating pain and determining its character and severity. In keeping with the ALARA (As Low As Reasonably Achievable) protocol, the number of imaging tests possible to perform is very limited. Ultrasound is the first line exam of choice. After diagnosis of the presence of a stone, ESWL (Extracorporeal Shock Wave Lithotrypsy) should always be considered and offered to parents due to its high effectiveness and minimal invasiveness. If ESWL is contraindicated or not well-accepted by parents, authors suggest another minimal invasive approach: URS-L (Uretherorenoscopy-Lithotrypsy). Our study clinically analyzes 87 children, which were treated between 2009 and 2017 using the URS-L procedure. URS-L treatments were performed using Lithoclast until 2009, and after that time, using the holmium laser Ho:YAG. The overall effectiveness of treatments was 93.3%. There was no failure in the access to the stones. A macroscopic hematuria (Clavien-Dindo I grade) was observed through the second post-operative day in 9.2% of treated patients. No urosepsis was observed. Full metabolic evaluation was performed on all patients. Children remained under constant urological and nephrological observation. A recurrence of urolithiasis was observed in 35.6% of the cases. Treating ureteral lithiasis in young infants remains a big challenge. Our series shows that modern minimal invasive techniques used by very experienced pediatric urologists in high volume centers gives excellent results. In most cases, surgery should no longer need to be an option.

Authors+Show Affiliations

Department of Paediatric Urology, "Klinika Wisniowa", "Cherry Clinic", Zielona Gora, Poland.Department of Paediatric Urology, "Klinika Wisniowa", "Cherry Clinic", Zielona Gora, Poland. Clinical Department of Paediatric Surgery and Urology, University Hospital in Zielona Góra, Zielona Góra, Poland.Department of Paediatrics, University of Zielona Góra, Zielona Góra, Poland.Department of Paediatric Urology, "Klinika Wisniowa", "Cherry Clinic", Zielona Gora, Poland.Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences, Poznan, Poland.Department of Paediatric Urology, "Klinika Wisniowa", "Cherry Clinic", Zielona Gora, Poland.Department of Pediatric Surgery, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31555620

Citation

Halinski, Adam, et al. "Interest of URS-L in the Treatment of Ureterolithiasis in Preschool Children." Frontiers in Pediatrics, vol. 7, 2019, p. 324.
Halinski A, Halinski A, Zaniew M, et al. Interest of URS-L in the Treatment of Ureterolithiasis in Preschool Children. Front Pediatr. 2019;7:324.
Halinski, A., Halinski, A., Zaniew, M., Kudliński, B., Soltysiak, J., Sobolewski, B., & Steyaert, H. (2019). Interest of URS-L in the Treatment of Ureterolithiasis in Preschool Children. Frontiers in Pediatrics, 7, p. 324. doi:10.3389/fped.2019.00324.
Halinski A, et al. Interest of URS-L in the Treatment of Ureterolithiasis in Preschool Children. Front Pediatr. 2019;7:324. PubMed PMID: 31555620.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interest of URS-L in the Treatment of Ureterolithiasis in Preschool Children. AU - Halinski,Adam, AU - Halinski,Andrzej, AU - Zaniew,Marcin, AU - Kudliński,Bartosz, AU - Soltysiak,Jolanta, AU - Sobolewski,Bartłomiej, AU - Steyaert,Henri, Y1 - 2019/09/06/ PY - 2019/03/27/received PY - 2019/07/18/accepted PY - 2019/9/27/entrez PY - 2019/9/27/pubmed PY - 2019/9/27/medline KW - DJ catheter KW - laser KW - preschool children KW - stone disease KW - ureterorenoscopy SP - 324 EP - 324 JF - Frontiers in pediatrics JO - Front Pediatr VL - 7 N2 - Urolithiasis can affect all children even preschool ones. Diagnostic difficulties in the youngest children are due to the problems in locating pain and determining its character and severity. In keeping with the ALARA (As Low As Reasonably Achievable) protocol, the number of imaging tests possible to perform is very limited. Ultrasound is the first line exam of choice. After diagnosis of the presence of a stone, ESWL (Extracorporeal Shock Wave Lithotrypsy) should always be considered and offered to parents due to its high effectiveness and minimal invasiveness. If ESWL is contraindicated or not well-accepted by parents, authors suggest another minimal invasive approach: URS-L (Uretherorenoscopy-Lithotrypsy). Our study clinically analyzes 87 children, which were treated between 2009 and 2017 using the URS-L procedure. URS-L treatments were performed using Lithoclast until 2009, and after that time, using the holmium laser Ho:YAG. The overall effectiveness of treatments was 93.3%. There was no failure in the access to the stones. A macroscopic hematuria (Clavien-Dindo I grade) was observed through the second post-operative day in 9.2% of treated patients. No urosepsis was observed. Full metabolic evaluation was performed on all patients. Children remained under constant urological and nephrological observation. A recurrence of urolithiasis was observed in 35.6% of the cases. Treating ureteral lithiasis in young infants remains a big challenge. Our series shows that modern minimal invasive techniques used by very experienced pediatric urologists in high volume centers gives excellent results. In most cases, surgery should no longer need to be an option. SN - 2296-2360 UR - https://www.unboundmedicine.com/medline/citation/31555620/Interest_of_URS-L_in_the_Treatment_of_Ureterolithiasis_in_Preschool_Children L2 - https://doi.org/10.3389/fped.2019.00324 DB - PRIME DP - Unbound Medicine ER -