CODE: 17 - Ureteroscopic lithotrypsy in upper urinary tract lithiasis in children
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Marcin Życzkowski, Maciej Szczębara, Andrzej Paradysz, Mieczysław Fryczkowski

Katedra i Klinika Urologii w Zabrzu Śląskiej Akademii Medycznej w Katowicach

summary

Introduction. Ureteroscopic lithotrypsy (URSL) becomes recognized management of ureter lithiasis in children of various age. Nowadays, technological and instrumental development allowed using this method in urolithiasis of various parts of ureter. Progress in application of URSL is also described by permanently decreasing age of treated children.

Objectives. The aim of the study was to evaluate the results of URSL in children with ureterolithiasis.

Materials and methods. From January 1995 to January 2006 URSL was performed in 35 children aged 1-17 years (mean 8 years). There were 16 boys and 19 girls in this group. The most frequent indication for URSL was lithiasis of lower ureter - 14 cases (40%). The medium ureter localization were found in 12 children (34.3%), and upper ureter localization in 8 (22.8%). In 1 child (2.9%) indication for this method was alien corpus in ureter. Other, associated with urolithiasis, urinary tract defects: primary reflux megaureter, neurogenic bladder, vesicoureteral reflux and ureterocoele were noted in 14 children (40%). The procedure was performed with use of ureteroscope diameter 9.5 F.

Results. The method has been proved effective in 91.4% of cases, regardless of the stone location. Total deposit disintegration was obtained in 20 children (57.1%). Partial fragmentation with pieces evacuation were performed in 3 children (8.57%) and fragmentation where pieces were left to spontaneous elimination in 6 (17.14%). Pulling out the whole stone or alien corpus was done in 3 cases (8.57%). In 2 children (5.71%) procedure was unsuccessful and in 1 case (2.86%) - stone in middle part of ureter - perforation of ureter occurred with subsequent need of reconstructive operation. 6 patients (17.14%) after procedure had recurrent urinary tract infection, 4 of them with earlier diagnosed vesicoureteral reflux. Insignificant clinical complication after procedure: transient haematuria and mild colics occurred in 7 children (20%).

Conclusions. 1. URSL is quick and effective method of treatment of upper urinary tract lithiasis in children. 2. Indication to URSL should be carefully considered taking into account possibility of use of less aggressive methods of treatment.