Single Session Ureteroscopic Laser Lithotripsy for Paediatric Ureteral Stones in Mosul: A Prospective Study 2020

Abstract

Backgound: The incidence of pediatric urinary stones increased 4% per year during 1984-2008. Hematuria (Gross or microscopic) is seen in 30% to 55% of all pediatric urolithiasis. Nearly, 25-50% of pediatric ureteral stones need surgical intervention like  ureteroscopy.

Patients and Methods: In 2020, a prospective clinical study was done over a six months period (June to December) at the department of urology in Mosul Medical City. All children 14 years of age and below of both genders who presented with ureteric stones unpredictable for spontaneous passage were studied while cases with urologic comorbidities that necessitate open surgery were excluded. Abdomino-pelvic ultrasonography, plain abdominal radiography (KUB) and either intravenous urography (IVU) or computed tomography urogram (CTU) were done for all patients to identify stone characteristics (size, diameter, density and impaction) or ureteral state (dilatation or stricture).

Results: seventeen cases of semirigid ureteroscopic Ho:YAG laser lithotripsy procedures were performed. Their average age was (5.64) years, male to female ratio was 12:5. Abdominal pain and fever were the commonest presenting symptoms (76.4%). The overall stone clearance following one session of ureteroscopic laser lithotripsy was 88.2% i.e. clearance was achieved in 15 out of 17 procedures (88.2%) whereas the remaining 2 out of 17 (11.8%); needed retreatment; one case required 2nd session ureteroscopy while the other had stone migration up to renal pelvis which was treated by stenting and later on by SWL. On comparing the stone free rates in relation to their sites in the ureter or to their diameters the P-values were not significant. The post-operative complications were faced in 4 cases only (23.5%), fever in 3 cases (17.6%), while retrograde stone migration was in 1 case (5.9%).

Conclusion: Semi rigid ureteroscopic Ho:YAG laser lithotripsy is safe and effective in treating pediatric age group complaing from ureteral stones of different characteristics with a high clearance rate in single session procedures.