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21 November 2014 : Original article  

Holmium Laser Lithotripsy with Semi-Rigid Ureteroscopy: A First-Choice Treatment for Impacted Ureteral Stones in Children?

Senol AdanurAE, Hasan Riza AydinF, Fatih OzkayaB, Tevfik ZiypakC, Ozkan PolatD

DOI: 10.12659/MSM.891173

Med Sci Monit 2014; 20:2373-2379

Abstract

BACKGROUND: We aimed to assess the effectiveness of semi-rigid ureteroscopy and holmium laser lithotripsy in the treatment of impacted ureteral stones in children.

MATERIAL AND METHODS: We evaluated a total of 32 children under the age of 18 years treated with ureteroscopic holmium laser lithotripsy for impacted ureteral stones between January 2005 and July 2013. Their stone-free state was defined as the absence of any residual stone on radiologic evaluation performed 4 weeks postoperatively. Complications were evaluated according to the modified Clavien classification.

RESULTS: The mean patient age was 9.5±5.1 years (range 1–18 years). Seven (21.8%) of the stones were located in the proximal ureter, 9 (28.2%) were in the mid-ureter, and 16 (50%) were in the distal ureter. The mean stone size was calculated as being 10.46±3.8 mm2 (range 5–20). The stone-free rate was 93.75% (30/32 patients) following primary URS. Additional treatment was required for only 2 (6.25%) of the patients. After the procedure, a D-J stent was placed in all the patients. The total complication rate was 15.6% (5 patients). The 10 total complications in these 5 patients were 5 (15.6%) Grade I, 1 (3.1%) Grade II, 2 (6.25%) Grade IIIa, and 2 (6.25%) Grade IIIb. The mean follow-up period was 16.5 months (range 3–55).

CONCLUSIONS: For the treatment of impacted ureteral stones in children, holmium laser lithotripsy with semi-rigid ureteroscopy, with its low retreatment requirement and acceptable complication rates, is an effective and reliable method in experienced and skilled hands as a first-choice treatment approach.

Keywords: Child, Adolescent, Child, Preschool, Demography, Lasers, Solid-State - adverse effects, Lithotripsy, Laser - adverse effects, Postoperative Complications - etiology, Ureteral Calculi - therapy, Ureteroscopy

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750