The efficacy of holmium laser therapy together with ultra-thin semirigid ureterorenoscope in children under the age of 3 years with ureteral stones in different localizations

INTRODUCTION: We aimed to evaluate the success of semirigid (4.5 F) ureterorenoscopy in our clinic in the treatment of ureteric stones in children under 3 years of age
METHODS: We retrospectively evaluated 25 patients (12 female, 13 male) who underwent endoscopic ureteral stone treatment for ureteral stones between January 2012 and March 2017 in our clinic. There were unsuccessful Extracorporeal Shock Wave Lithotripsy attempts before ureterorenoscopy treatment of the 7 patients with proximal ureteral stones. During the procedure 4.5 F semirigid ultrathin ureterorenoscopy and holmium: YAG laser as lithotripter were used. Evaluation of the stone-free status of the patients was made visually during the fragmentation and by urinal ultrasonography 1 week later.
RESULTS: 52.0% (n = 13) of the patients were male and 48% (n = 12) were female. The mean age was 2.08 ± 0.9 (range 1-3 years). 64% of the stones (n = 16) were located distally, 8% (n = 2) in the mid and 28% (n = 7) in the proximal ureter. The stones were in the left ureter in 76% of the patients (n = 19) and in the right ureter in 24% (n = 6). The stone-free rate after the first ureterorenoscopy procedure was 92% (23/25). Second ureterorenoscopy treatment was applied to 2 patients who had impacted stones in proximal ureter.
DISCUSSION AND CONCLUSION: In endoscopic ureteral stone treatment with a 4.5 F ultrathin ureterorenoscopy can applied safely with high success and low complication rates even in very young patients.

Farklý Lokalizasyonlarda Üreter Taþlarý Olan 3 Yaþ Altý Çocuklarda Ultrathin Semirijid Üreterorenoskopi Eþliðinde Holmium Lazer Tedavisinin Etkinliði

GÝRÝÞ ve AMAÇ: Kliniðimizde kullandýðýmýz semirijit (4.5 F) üreterorenoskopun 3 yaþ altý çocuklarda üreter taþý tedavisindeki baþarýsýný deðerlendirmeyi hedefledik.
YÖNTEM ve GEREÇLER: 2012 Ocak-2017 Mart yýllarý arasýnda kliniðimizde üreter taþý nedeniyle endoskopik üreter taþý tedavisi yapýlan 12’i kýz, 13’si erkek toplam 25 hastanýn verileri retrospektif deðerlendirildi. Proksimal üreter yerleþimli taþý olan 7 hastanýn Üreterorenoskopi tedavisinden önce baþarýsýz Vücut dýþý þok dalga litotripsinin giriþimi mevcuttu. Ýþlem esnasýnda 4,5 F semirijid ultrathin Üreterorenoskopi ve litotiriptör olarak holmium: YAG lazer kullanýldý. Hastalarýn taþsýzlýk oranlarýnýn deðerlendirilmesi fragmantasyon esnasýnda vizüel olarak ve 1 hafta sonra üriner ultrasonografi ile yapýldý.
BULGULAR: Hastalarýn %52.0’i (n=13) erkek olup, %48’i (n=12) kýz hastaydý. Yaþ ortalamasý 2.08±0.9 (1–3 yaþ aralýðý) idi. Taþlarýn %64’ü (n=16) distal üreter, %8’i (n=2) orta üreter, %28’i (n=7) proksimal üreter yerleþimli idi. Hastalarýn %76’inde (n=19) taþlar sol üreterde, %24’ünde (n=6) sað üreterde idi. Ýlk üreterorenoskop prosedürü sonrasý taþsýzlýk oraný %92 (23/25) idi. Proksimal üreterde impakte taþý olan 2 hastaya 2. seans üreterorenoskop uygulandý.
TARTIÞMA ve SONUÇ: Kalibrasyonu 4.5 F olan üreterorenoskopi ile uygulanan endoskopik üreter taþý tedavisinde, çok küçük yaþtaki hastalarda bile yüksek baþarý ve düþük komplikasyon oranlarý ile güvenle uygulanabilmektedir.