Resorlu Berkan, Kara Cengiz, Resorlu Eylem Burcu, Unsal Ali
Ministry of Health, Kecioren Training and Research Hospital, Ankara, Turkey.
Pediatr Surg Int. 2011 Dec;27(12):1337-41. doi: 10.1007/s00383-011-2979-0. Epub 2011 Sep 28.
To evaluate the effectiveness of ultrasonography and to determine whether ionizing radiation is necessary in the postoperative follow-up of children undergoing ureteroscopy.
We reviewed the charts of 49 children who underwent 51 ureteroscopic procedures for ureteral calculi. Renal ultrasound and intravenous urography were performed in all patients at 3 months after surgery for postoperative evaluation.
In three cases, stones migrated to the kidney. Retrograde intrarenal surgery was performed in two patients and one patient required shockwave lithotripsy to become stone-free. Fourty-six children were completely stone-free and 3 had residual fragments on plain film in the postoperative 3 month. The sensitivity, specificity, negative and positive predictive values of ultrasonography for detecting hydronephrosis were 85.7, 100, 97.7 and 100%, respectively. Two patients under observation and three patients under medical expulsive therapy had resolution of hydronephrosis on follow-up. One patient required ureteroscopy for residual obstructing fragments.
Ultrasonography has limited accuracy for detecting residual ureteral stones, but it is a highly specific and reasonably sensitive test for detecting hydronephrosis. A combination of ultrasonography and plain film is a safe and effective imaging procedure in postoperative follow-up of children undergoing ureteroscopy.
评估超声检查的有效性，并确定接受输尿管镜检查的儿童术后随访中是否需要电离辐射。
我们回顾了49例接受51次输尿管镜治疗输尿管结石的儿童病历。所有患者在术后3个月均接受肾脏超声和静脉肾盂造影检查以进行术后评估。
3例结石迁移至肾脏。2例患者接受了逆行肾内手术，1例患者需要冲击波碎石术以达到无结石状态。46例儿童术后3个月时结石完全清除，3例在平片上有残留碎片。超声检查检测肾积水的敏感性、特异性、阴性预测值和阳性预测值分别为85.7%、100%、97.7%和100%。2例观察中的患者和3例接受药物排石治疗的患者在随访时肾积水得到缓解。1例患者因残留梗阻性碎片需要进行输尿管镜检查。
超声检查检测残留输尿管结石的准确性有限，但它是检测肾积水的高度特异性且相当敏感的检查。超声检查和平片相结合是接受输尿管镜检查儿童术后随访的安全有效的成像方法。
