| Ureteroscopy in the management of pediatric urinary tract calculi. | |
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MedLine Citation:
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PMID: 15798409 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: To report our experience with ureteroscopy in the treatment of pediatric urinary tract calculi and present a review of the literature. PATIENTS AND METHODS: Between 1988 and 2003, 52 ureteroscopic procedures were performed in 25 male and 10 female children aged 11 months to 15 years (mean 5.9 years). Using a semirigid 6.8F 43-cm ureteroscope and routine antibiotic prophylaxis, stones were fragmented with a pulsed-dye laser (N = 14; stone size 6-15 mm with a mean of 9.6 mm), electrohydraulic lithotripsy (EHL) (N = 26; stone size 3-20 mm with a mean of 8.4 mm), or a holmium laser (N = 7; stone size 5-15 mm with a mean of 10 mm); removed by basket extraction (N = 5; stone size 5-8 mm with a mean of 7 mm); or both. Stenting or ureteral dilatation was not performed routinely. RESULTS: With the pulsed-dye laser, there was an overall stone-free rate of 72%. Complications consisted of one ureteral perforation and one stenosis of the intramural portion of a megaureter (14% complication rate). With EHL, the overall stone-free rate was 92%. Complications consisted of one case each of ureteral perforation and incipient urinary retention and five of mild fever (27%). With the holmium laser, the overall stone-free rate was 100%, and there were no complications. Basketing likewise produced a 100% stone-free rate, and there was one complication, a mucosal tear in a patient who also underwent pulsed-dye laser lithotripsy. CONCLUSION: Ureteroscopy is a safe and effective means of treating the majority of pediatric ureteral calculi, although retreatment rates are higher with multiple stones and in younger children. Dilatation of the vesicoureteral junction is usually not necessary with ureteroscopes <8F, nor is ureteral drainage required after uncomplicated ureteroscopy. The holmium laser is the most effective and safest method of fragmentation regardless of stone composition. Ureteroscopy for this indication should be performed only by an experienced endoscopist. |
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Authors:
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Asif Raza; Gordon Smith; Sami Moussa; David Tolley |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of endourology / Endourological Society Volume: 19 ISSN: 0892-7790 ISO Abbreviation: J. Endourol. Publication Date: 2005 Mar |
Date Detail:
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Created Date: 2005-03-30 Completed Date: 2005-05-31 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8807503 Medline TA: J Endourol Country: United States |
Other Details:
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Languages: eng Pagination: 151-8 Citation Subset: IM |
Affiliation:
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The Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, Scotland, UK. araza36624@aol.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Antibiotic Prophylaxis Child Child, Preschool Female Humans Infant Laser Therapy* Lithotripsy / adverse effects, methods* Male Reoperation Treatment Outcome Ureteroscopes Ureteroscopy* Urinary Calculi / therapy* |
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