Liu Li,Li Chuangye,Zhao Yaowang,et al.Flexible ureteroscopic lithotripsy for upper urinary tract calculi in children[J].Journal of Clinical Pediatric Surgery,,21():866-870.[doi:10.3760/cma.j.cn101785-202205066-013]
Flexible ureteroscopic lithotripsy for upper urinary tract calculi in children
- Keywords:
- Calculi/SU; Lithotripsy; Laser; Ureteroscopes
- Abstract:
- Objective To evaluate the efficacy and safety of flexible ureteroscopy for upper urinary tract calculi in children.Methods Between March 2015 to March 2021, clinical data were retrospectively reviewed for 215 children with upper urinary tract calculi undergoing flexible ureteroscopy. With a total of 239 involved sides, there were 141 boys and 74 girls with a mean age of 4.6(1.2-14.4) years. There were renal calculi (n=179;bilateral n=19) and upper ureteral calculi (n=36;bilateral n=5). The diameter of calculi ranged from 5 to 28 mm. All of them were diagnosed preoperatively by urinary tract ultrasonography, spiral computed tomography (CT) or intravenous urography imaging (IVP) without severe urinary tract anomalies.Results The initial insertion of ureteric access sheath and flexible ureteroscope was successful for 19 sides. And 209 sides of ureter were successfully dilated by double-J stent for 4 weeks. Mini-invasive percutaneous nephrolithotomy (MPCNL) was performed for another 11 sides. Flexible ureteroscope was successfully inserted for 228 sides. In addition to 5 cases with small stone burdens and minimal intraoperative bleeding, others were managed with double J stenting for about 2-4 weeks post-operation. Stone-free status was routinely determined by urinary tract ultrasonography or spiral CT. And 148/228 sides (64.9%) remained stone-free at 4 weeks after primary operation and overall stone-free rate was 89.9%(205/228) at 3 months. Ureteroscopic procedures were performed twice or thrice for 75 sides. The average operative duration was 55(25-115) min and average postoperative length of stay 3.5(2-5) days. Severe complications included laceration at ureteral orifice (n=5) and injury at ureteropelvic junction (n=3). The latter included perforation at ureteropelvic junction (n=1). All of them were managed with double J stenting. There was one case of renal hematoma. During follow-ups, one child of stricture of ureteropelvic junction was cured by pyeloureteroplasty 6 months later. Up until March 2022, recurrent calculi were detected (n=10).Conclusion Combining flexible ureteroscopy and holmium laser lithotripsy is both safe and effective for upper tract calculi in children. It offers high stone-free rate and fewer complications.
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Memo
收稿日期:2022-05-22。
基金项目:湖南省重点研发计划（2020SK2112）； 湖南省卫生厅应用研究项目（B2014-125）
通讯作者:赵夭望,Email:yw508@sina.com