Dogan Hasan S, Tekgul Serdar, Akdogan Bulent, Keskin Mehmet S, Sahin Ahmet
Faculty of Medicine, Department of Urology, Hacettepe University, Ankara, Turkey.
BJU Int. 2004 Jul;94(1):131-3. doi: 10.1111/j.1464-4096.2004.04873.x.
To review our experience with rigid ureteroscopy and holmium:YAG laser for treating ureteric calculi in children.
The study included 35 children who were treated with rigid ureteroscopy for ureteric calculi between November 1997 and June 2003 (15 boys and 20 girls; mean age 6.2 years, range 1-14). The mean (range) stone size was 8 (4-15) mm and the duration of anaesthesia 46.6 (15-90) min. The stone was in the distal third of the ureter in 33 children and in the proximal third in two. We used a 7.5/8/10 F rigid ureteroscopes with routine dilatation of the ureteric orifice. For lower ureteric stones, lithotripsy was carried out with holmium:YAG laser in 29 cases, a pneumatic impactor in two and forceps extraction in two. Both stones in the proximal ureter were pushed back into the collecting system. All the ureters were stented using JJ stents in 31 and ureteric catheters in four cases. The mean postoperative follow-up was 12 (2-30) months.
Excluding the two stones pushed back, the stone-free rate after a one-stage procedure was 82% (27/33). With repeated procedures in the six (ESWL in two) remaining cases the success rate was 97% (32/33). The ureter was perforated in two patients within the first five in the series. There was no pyelonephritis or gross haematuria after surgery.
Ureteroscopy and lithotripsy using the holmium:YAG laser is effective and safe for treating ureteric stones in children, in experienced hands. The results would be even better using smaller and flexible ureteroscopes.
回顾我们使用硬性输尿管镜和钬激光治疗儿童输尿管结石的经验。
本研究纳入了1997年11月至2003年6月间接受硬性输尿管镜治疗输尿管结石的35例儿童（15例男孩，20例女孩；平均年龄6.2岁，范围1 - 14岁）。结石平均（范围）大小为8（4 - 15）mm，麻醉时间为46.6（15 - 90）分钟。33例患儿结石位于输尿管远端三分之一处，2例位于近端三分之一处。我们使用7.5/8/10F硬性输尿管镜并常规扩张输尿管口。对于下段输尿管结石，29例采用钬激光碎石，2例采用气压弹道碎石，2例采用钳取法。近端输尿管的2颗结石均被推回集合系统。31例输尿管均置入了双J管，4例置入了输尿管导管。术后平均随访时间为12（2 - 30）个月。
排除2颗被推回的结石，一期手术后结石清除率为82%（27/33）。其余6例（其中2例接受了体外冲击波碎石术）经重复手术，成功率为97%（32/33）。该系列前5例中有2例发生输尿管穿孔。术后无肾盂肾炎或肉眼血尿。
对于有经验的术者，输尿管镜下钬激光碎石术治疗儿童输尿管结石有效且安全。使用更小的软性输尿管镜，效果会更佳。
