Van Savage J G, Palanca L G, Andersen R D, Rao G S, Slaughenhoupt B L
Division of Pediatric Urology, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA.
J Urol. 2000 Sep;164(3 Pt 2):1089-93. doi: 10.1097/00005392-200009020-00043.
The American Urological Association (AUA) published clinical guidelines for the treatment of ureteral calculi in adults and note that up to 98% of stones less than 5 mm. in diameter will pass spontaneously. Ureteroscopy and shock wave lithotripsy were acceptable treatment choices for stones less than 10 mm. in diameter in the distal ureter. We reviewed our management of distal ureteral stones in children to see if the AUA Guidelines for adults would apply.
A total of 14 males and 19 females with a mean age of 12 years (range 0.5 to 17) required hospitalization in the last 6 years for distal ureteral obstruction due to stones. Excretory urography or computerized tomography was performed in all cases, and mean stone size was 4 mm. (range 1 to 15). When stones did not pass spontaneously most patients were treated with ureteroscopic laser lithotripsy.
There were 12 (36%) with a mean age of 11 years and a mean stone size of 2 mm. (range 1 to 3) who passed stones spontaneously with intravenous hydration and narcotics. No child passed a stone 4 mm. or greater spontaneously in this series. Of 21 patients (64%) with a mean age of 12 years and a mean stone size of 5 mm. (range 1 to 15) 2 were treated with ureteral stents, 17 with ureteroscopic lithotripsy and 2 with shock wave lithotripsy. All patients were stone-free at the end of the procedures. The stone composition was predominantly calcium oxalate. Mean followup was 2 years.
Similar to the AUA guidelines in adults, most stones less than 3 mm. in diameter in the distal ureter of children will pass spontaneously. Stones 4 mm or greater in the distal ureter are likely to require endosurgical treatment. Ureteroscopy and shock wave lithrotripsy have a high success rate for stones between 4 and 15 mm. in the distal ureter. Needle ureteroscope and laser lithotripsy have allowed more stones to be treated safely and effectively in smaller children.
美国泌尿外科学会（AUA）发布了成人输尿管结石治疗的临床指南，并指出直径小于5mm的结石中，高达98%会自行排出。输尿管镜检查和冲击波碎石术是治疗远端输尿管直径小于10mm结石的可接受治疗选择。我们回顾了我们对儿童远端输尿管结石的处理情况，以确定AUA成人指南是否适用。
在过去6年中，共有14名男性和19名女性因结石导致远端输尿管梗阻而住院，平均年龄12岁（范围0.5至17岁）。所有病例均进行了排泄性尿路造影或计算机断层扫描，平均结石大小为4mm（范围1至15mm）。当结石未自行排出时，大多数患者接受了输尿管镜激光碎石术治疗。
12例（36%）平均年龄11岁，平均结石大小2mm（范围1至3mm）的患者通过静脉补液和使用麻醉剂后结石自行排出。在本系列中，没有儿童自行排出直径4mm或更大的结石。21例（64%）平均年龄12岁，平均结石大小5mm（范围1至15mm）的患者中，2例接受了输尿管支架置入术，17例接受了输尿管镜碎石术，2例接受了冲击波碎石术。所有患者在手术结束时结石均消失。结石成分主要为草酸钙。平均随访2年。
与AUA成人指南相似，儿童远端输尿管直径小于3mm的大多数结石会自行排出。远端输尿管直径4mm或更大的结石可能需要内镜手术治疗。输尿管镜检查和冲击波碎石术治疗远端输尿管4至15mm的结石成功率很高。针状输尿管镜和激光碎石术使更小的儿童能够更安全有效地治疗更多结石。
