Kucukdurmaz Faruk, Efe Erkan, Sahinkanat Tayfun, Amasyalı Akın Soner, Resim Sefa
Department of Urology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
Department of Urology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
Urology. 2018 Jan;111:162-167. doi: 10.1016/j.urology.2017.09.006. Epub 2017 Sep 21.
To evaluate the factors that may affect the efficacy and safety of ureteroscopy with holmium:YAG laser lithotripsy in the management of ureteral stones in preschool children.
Medical records of 70 children, 32 boys and 38 girls, who were treated for ureteral stones at our clinic between 2014 and 2016 were retrospectively reviewed. Patients were grouped according to size of the instrument used as group 1 (n = 40, ultrathin 4.5 Fr) and group 2 (n = 30, 7.5 Fr). Patient age, stone characteristics, and operative and postoperative outcomes were compared. The effect of age, stone size and location, type of the instrument, and operative times on success and complication rates were also investigated. In addition, factors related with postoperative hydronephrosis were evaluated.
Patients in group 1 were significantly younger than group 2 (32.22 ± 22.72 vs 63.53 ± 16.98 months, P = .000). Groups were similar in terms of gender, stone laterality, size and location, and operative times. However, access failure rate was significantly higher in group 2 (0 vs 20%, P = .022). Stone-free rate was 87.5% in group 1 and 76.6% in group 2 (P = .237), complication rates were not significantly different among groups. Stone size and location were found to be associated with success rates. Stone location and operative times were the factors affecting the complication rates. Presence of preoperative hydronephrosis and prolonged operative time were determined as the predictors of postoperative hydronephrosis.
Ultrathin ureteroscopy with laser lithotripsy can be used safely and effectively for ureteral calculi including proximal ones in significantly younger children without any access failure.
评估可能影响钬激光输尿管镜碎石术治疗学龄前儿童输尿管结石疗效及安全性的因素。
回顾性分析2014年至2016年在我院接受输尿管结石治疗的70例儿童（32例男孩，38例女孩）的病历资料。根据所用器械大小将患者分为1组（n = 40，超薄4.5Fr）和2组（n = 30，7.5Fr）。比较患者年龄、结石特征以及手术和术后结果。还研究了年龄、结石大小和位置、器械类型及手术次数对成功率和并发症发生率的影响。此外，评估与术后肾积水相关的因素。
1组患者明显比2组患者年轻（32.22±22.72个月 vs 63.53±16.98个月，P = 0.000）。两组在性别、结石侧别、大小和位置以及手术次数方面相似。然而，2组的进镜失败率明显更高（0 vs 20%，P = 0.022）。1组结石清除率为87.5%，2组为76.6%（P = 0.237），各组间并发症发生率无显著差异。发现结石大小和位置与成功率相关。结石位置和手术次数是影响并发症发生率的因素。术前肾积水的存在和手术时间延长被确定为术后肾积水的预测因素。
超薄输尿管镜联合激光碎石术可安全有效地用于治疗年龄更小的儿童的输尿管结石，包括近端结石，且无进镜失败情况。
