Is Ureteroscopy First Line Treatment for Pediatric Stone Disease?
| Autor: | Marc C. Smaldone, Steven G. Docimo, Ethan G. Polsky, Hsi-Yang Wu, Mark F. Bellinger, Glenn M. Cannon, Jeffrey C. Bassett, Francis X. Schneck |
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| Rok vydání: | 2007 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Urology medicine.medical_treatment Decision Making Lithotripsy Severity of Illness Index Disease-Free Survival Kidney Calculi Ureter Ureteroscopy medicine Humans Child Percutaneous nephrolithotomy Retrospective Studies Ultrasonography medicine.diagnostic_test business.industry Infant Newborn Infant Stent medicine.disease Surgery Endoscopy Treatment Outcome medicine.anatomical_structure Child Preschool Female Tomography X-Ray Computed business Renal pelvis Follow-Up Studies Kidney disease |
| Zdroj: | Journal of Urology. 178:2128-2131 |
| ISSN: | 1527-3792 0022-5347 |
| DOI: | 10.1016/j.juro.2007.07.050 |
| Popis: | We report our current outcomes for ureteroscopic management of pediatric stone disease.We carried out a retrospective review of all ureteroscopic procedures for kidney or ureteral calculi performed between 2001 and 2005. Stone location and size, preoperative and postoperative stenting, intraoperative dilation, use of ureteral access sheath, stone-free rates and complications were noted.A total of 100 patients (58% female, mean age 13.2 years) underwent 115 procedures. Stones were located in the renal pelvis in 6% of patients, upper pole in 10%, mid ureter in 11%, lower pole in 17%, proximal ureter in 19% and distal ureter in 37%. Mean stone size was 8.3 mm (median 7.0), with a mean of 1.5 stones per patient. Preoperative stenting was used in 54% of patients, and a stent was placed postoperatively in 76%. Ureteral coaxial dilators and ureteral access sheaths were used in 70% and 24% of patients, respectively. There were no major intraoperative complications, although 5 patients required stent placement for ureteral perforation or extravasation. One patient had a ureteral stricture requiring ureteral reimplantation. Mean followup was 10.1 months (median 2.6). Stone-free rate was 91% on followup ultrasound, abdominal radiography or computerized tomography. Seven patients required staged ureteroscopic procedures to achieve stone-free status. While the number of percutaneous nephrolithotomy and shock wave lithotripsy cases remained stable, the number of ureteroscopic cases increased 7-fold during this period.Improved ureteroscopic access to stones throughout the pediatric urinary tract and stone-free rates that are comparable to the adult population have led to the adoption of ureteroscopy as first line therapy in children at our institution. |
| Databáze: | OpenAIRE |
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