Reeves Thomas, Griffin Stephen, Pietropaolo Amelia, Somani Bhaskar K
Department of Urology, University Hospital Southampton NHS Foundation Trust, United Kingdom.
Department of Paediatric Urology, Southampton Children's Hospital, United Kingdom.
Cent European J Urol. 2019;72(4):398-401. doi: 10.5173/ceju.2019.0009. Epub 2019 Sep 26.
As the role of paediatric ureteroscopy (URS) for stone disease increases, new methods of stone treatment such as dusting and pop-dusting have emerged. However, outcomes of treatment using these laser settings in paediatric age group is still largely unknown. We aimed to look at the feasibility and outcomes of URS and pop-dusting using a high-power 100W laser for paediatric stone patients.
Outcomes from a prospective stone database were reviewed over a period of 30 months from February 2016-July 2018. All paediatric patients (≤16 years) treated with dusting and pop-dusting were included in our study. Dusting and pop-dusting were performed using Ho:YAG laser with the energy setting ranges of 0.2-0.5 J and 0.5-0.7 J respectively with a frequency of 20-50 Hz.
Twelve patients underwent URS and treatment using this method with mean age of 6.5 years and a male:female ratio of 7:5. The mean and cumulative single stone size was 7.1 mm (3-10 mm) and 11.9 mm (6-40 mm) respectively with half of all patients having multiple stones. Eleven patients were stone free on follow-up with no intra or post-operative complications noted.
Pop-dusting using holmium laser is a new hybrid technique that allows for more efficient dust formation even for hard stones. This is the first clinical study demonstrating the safety and efficacy of this technique in paediatric patients. It is likely there will be wider adoption of these new laser techniques for stone treatment in the paediatric age group.
随着小儿输尿管镜检查（URS）在结石病治疗中的作用不断增加，诸如粉末化和爆破粉末化等新的结石治疗方法应运而生。然而，在小儿年龄组中使用这些激光设置的治疗结果仍大多未知。我们旨在探讨使用高功率100W激光对小儿结石患者进行URS和爆破粉末化的可行性及治疗结果。
回顾了2016年2月至2018年7月期间30个月的前瞻性结石数据库的结果。我们的研究纳入了所有接受粉末化和爆破粉末化治疗的小儿患者（≤16岁）。使用钬激光进行粉末化和爆破粉末化，能量设置范围分别为0.2 - 0.5J和0.5 - 0.7J，频率为20 - 50Hz。
12例患者接受了URS及该方法治疗，平均年龄6.5岁，男女比例为7:5。平均单颗结石大小和累积结石大小分别为7.1mm（3 - 10mm）和11.9mm（6 - 40mm），半数患者有多颗结石。11例患者随访时结石清除，未发现术中或术后并发症。
钬激光爆破粉末化是一种新的混合技术，即使对于坚硬结石也能更有效地形成粉末。这是第一项证明该技术在小儿患者中安全性和有效性的临床研究。小儿年龄组中这些新的激光结石治疗技术可能会得到更广泛的应用。
