Thomas John C, DeMarco Romano T, Donohoe Jeffrey M, Adams Mark C, Brock John W, Pope John C
Division of Pediatric Urology, Vanderbilt Children's Hospital, Nashville, Tennessee 37232-2765, USA.
J Urol. 2005 Sep;174(3):1072-4. doi: 10.1097/01.ju.0000169159.42821.bc.
We reviewed our experience of 5 years using ureteroscopy with laser lithotripsy to treat stone disease in prepubertal children.
A retrospective review was performed of all ureteroscopic procedures performed in prepubertal children.
A total of 33 ureteroscopic procedures were performed in 29 prepubertal children (15 males and 14 females) 5 to 144 months old (mean age 94 months, including 3 patients 24 months or younger). Stones were located in the renal pelvis in 1 case (3%), proximal ureter in 3 (9%), mid ureter in 5 (15%) and distal ureter in 24 (73%). Stone size ranged from 3 to 14 mm (mean 6). Eight patients required balloon dilation of the ureteral orifice. Followup ranged from 1 to 66 months (mean 11). Stone-free rate after initial ureteroscopy and laser lithotripsy was 88%, with all distal and mid ureteral stones (3 to 9 mm, mean 5) successfully treated. Three patients with proximal ureteral stones 7 to 14 mm in diameter (mean 10.3) required a secondary procedure (repeat ureteroscopy in 2 and shock wave lithotripsy in 1) to become stone-free. One patient with cystinuria and a renal pelvic stone measuring 14 mm required shock wave lithotripsy and percutaneous nephrostolithotomy. There were no major complications of ureteroscopy but there was 1 case of extravasation at the ureterovesical junction after balloon dilation that was managed with stent placement.
Although more patients and longer followup are needed, ureteroscopy with laser lithotripsy is an excellent first line treatment for children with stones in whom conservative therapy fails, especially those with distal and mid ureteral stones. Patients with a stone burden of 10 mm or greater, especially in the proximal ureter, likely will require a secondary procedure to become stone-free.
我们回顾了5年来使用输尿管镜联合激光碎石术治疗青春期前儿童结石病的经验。
对青春期前儿童所进行的所有输尿管镜手术进行回顾性分析。
29例青春期前儿童（15例男性，14例女性）共接受了33次输尿管镜手术，年龄5至144个月（平均年龄94个月，包括3例24个月及以下的患者）。结石位于肾盂1例（3%），输尿管上段3例（9%），输尿管中段5例（15%），输尿管下段24例（73%）。结石大小为3至14毫米（平均6毫米）。8例患者需要对输尿管口进行球囊扩张。随访时间为1至66个月（平均11个月）。初次输尿管镜检查及激光碎石术后结石清除率为88%，所有输尿管下段和中段结石（3至9毫米，平均5毫米）均成功治疗。3例输尿管上段结石直径为7至14毫米（平均10.3毫米）的患者需要二次手术（2例重复输尿管镜检查，1例冲击波碎石）才能清除结石。1例患有胱氨酸尿症且肾盂结石大小为14毫米的患者需要冲击波碎石和经皮肾镜取石术。输尿管镜检查无重大并发症，但有1例在球囊扩张后输尿管膀胱连接处出现外渗，通过放置支架处理。
尽管需要更多患者及更长时间的随访，但输尿管镜联合激光碎石术对于保守治疗失败的结石患儿是一种极佳的一线治疗方法，尤其是对于输尿管下段和中段结石的患儿。结石负荷为10毫米或更大的患者，尤其是输尿管上段结石患者，可能需要二次手术才能清除结石。
