Serhat GUROCAK, Metin ONARAN, Esat AK, M Ozgur TAN, Nuri DENİZ, İrfan ATAY, Fikret AHMADOV

Laser or Pneumatic Lithotripsy in Pediatric Ureteral Stones: Which One is More Effective?

Amaç: Bu retrospektif çalışmanın amacı çocukluk çağı üreter taşlarında pnömotik ve lazer litotripsinin etkinliğini karşılaştırmaktır. Yöntemler: Üreter taşı nedeniyle 2008-2012 yılları arasında takip edilen 60 hastanın, klinik değişkenleri, taş yeri ve taş yükü, kullanılan enerji kaynağı, komplikasyon oranları, takip süresi retrospektif olarak incelenmiştir. ESWL başarısızlığı, klinik anlamlı obstrüktif üropati ve akut semptomatik hastalar üreterorenoskopi endikasyonu olarak değerlendirilmiştir. Bulgular: Sırasıyla 36 ve 24 hastaya pnömotik ve lazer litotripsi yapılmıştır. Gruplar arasında cinsiyet (p=0.133), yaş (p=0.211), taş boyu (p=0.101), taş yükü (p=0.850) ve yeri (p=0.301) incelendiğinde anlamlı fark saptanmamıştır. Pnömotik ve lazer litotripsi sonrası sırasıyla 6(16%) ve 4(16.7%) hastada anlamlı rezidü izlenmiştir. Rezidü taşlar üreter üst uç taşlarının litotripsi sırasında yukarı kaçması sonucu olmuştur. Sonuç: Pediatrik populasyonda her iki litotripsi yöntemi de benzer şekilde etkin bulunmuştur. Öteki taraftan lazer litotripsinin komplikasyon oranlarının daha düşük olması lazer litotripsinin daha güvenli bir enerji kaynağı olduğunu göstermektedir

Çocukluk Çağı Üreter Taşlarında Lazer veya Pnömotik Litotripsi: Hangisi Daha Etkin?

Objective: The aim of this retrospective study was to compare the effectiveness of pneumatic and laser lithotripsy in the treatment of pediatric ureteral stones. Methods:Among 60 cases of ureteral stones with a complete clinical followup between 2008 and 2012, clinical variables of patients, localization and stone load before ureteroscopy, energy source of lithotripsy, complication rate and follow-up period were evaluated retrospectively. Indication for ureteroscopy was accepted as the failure of extracorporeal shockwave lithotripsy, clinically significant obstructive uropathy and acute symptomatic patients. Results: Thirty-six (60%) and 24 (40%) patients underwent the pneumatic and the laser lithotripsy, respectively. There was no statistically significant difference between the two groups preoperatively in terms of gender (p = 0.133), age (p = 0.211), stone size (p = 0.101), stone load (p = 0.850) and location (p = 0.301). After pneumatic and laser lithotripsy, 6 (16%) and 4 (16.7%) patients had clinically significant residual stones, respectively (p = 0.83). Residual stones were seen in the upper ureteral stones that migrated up during lithotripsy. Conclusion: Both of the lithotripsy methods were found to be equally effective in pediatric populations. On the other hand, lower complication rates obtained in laser lithotripsy incline us to use the laser lithotripsy because of its safety as an energy source

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Borgmann V, Nagel R. Urolithiasis in childhood. A study of 181 cases. Urol Int 1982; 37:198-204.
Straub M, Strohmaier WL, Berg W, Beck B, Hoppe B, Laube N, Lahme S, Schmidt M, Hesse A, Koehrmann KU. Diagnosis and metaphylaxis of stone disease. Consensus concept of the national working committee on stone disease for the upcoming german urolithiasis guideline. World J Urol 2005; 23:309-23.
Menon M, Resnick MI. Urinary lithiasis: etiology, diagnosis, and medical management. In: Campbell MF, Walsh PC, Retik AB, eds. Campbell's Urology 2002. 8th ed. Philadelphia, Pa.: Saunders,.p. 3225-35.
Van Savage JG, Palanca LG, Andersen RD, et al. Treatment of distal ureteric stones in children: similarities to the American Urological Association guidelines in adults. J Urol. 2000; 164:1089-93.
Ritchey M, Patterson DE, Kelalis PP et al. A case of pediatric ureteroscopic lasertripsy. J Urol 1988; 139:1272-4.
Lim DJ, Walker RD 3rd, Ellsworth PI, et al. Treatment of pediatric urolithiasis between 1984 and 1994. J Urol. 1996 ;156:702-5.
Türk C, Knoll T, Petrik A, Sarica K, Seitz C, Straub M et al. Guidelines on Urolithiasis 2010: 1-106.
Hosking DH, Smith WE, McColm SE. A comparison of extracorporeal shock wave lithotripsy and ureteroscopy under intravenous sedation for the management of distal ureteric calculi. Can J Urol. 2003; 10: 1780-4.
Verze P, Imbimbo C, Calcelmo G, Creta M, Palmieri A, Mangiapia F, Buonopane R, Mirone V. Extracorporeal shockwave lithotripsy vs ureteroscopy as first-line therapy for patients with single , distal ureteric stones : a prospective randomized study. BJU International 2010 ; 106:1748-52
Schuster TG, Russell KY, Bloom DA, Koo HP, Faerber GJ. Ureteroscopy for the treatment of urolithiasis in children. J Urol 2002 ;167:1813.
De Dominicis M, Matarazzo E, Capozza N, Collura G, Caione P. Retrograde ureteroscopy for distal ureteric stone removal in children. BJU Int. 2005;95:1049-52.
Minevich E, DeFoor W, Reddy P , Nishikina K, Wacksman J, Sheldon C, Erhard M Ureteroscopy is safe and effective in prepubertal children. J Urol 2005; 174:276- 9.
Galal EM, Fath El-Bab TK, Abdelhamid AM. Outcome of ureteroscopy for treatment of pediatric ureteral stones. J Pediatr Urol. 2013 Aug;9:476-8.
Lanquentin JM, Jichlinski P, Favre R, Von Niederhusern W. The Swiss Lithoclast J Urol 1990 part2 ; 143: 179A,abstract V-032.
Denstedt JD, Eberwein PE, Singh RR. The Swiss Lithoclast. a new device for intracorporeal lithotripsy. J Urol 1992; 148:1088-90.
Atar M, Bodakci MN, Sancaktutar AA et al. Comparison of pneumatic and laser lithotripsy in the treatment of pediatric ureteral stones. J Pediatr Urol. 2013;9:308-12.
Yucel S, Akin Y, Kol A, Danisman A, Guntekin E. Experience on semirigid ureteroscopy and pneumatic lithotripsy in children at a single center. World J Urol. 2011;29:719-23.
Uygun I, Okur MH, Aydogdu B, Arayici Y, Isler B, Otcu S. Efficacy and safety of endoscopic laser lithotripsy for urinary stone treatment in children. Urol Res. 2012;40:751-5.
Ashish C Koura, Indupur R. Ravish et al. Ureteroscopic stone management in prepubertal children. Pediatr Surg Int 2007; 23:1123-6.
Hussein NS, Gohar MR. Pneumatic ureterolithotripsy in pediatric and adolescent patients:a ten-year experience at the Hospital Universiti Sains Malaysia. Singapore Med J 2011; 52: 42.
Seong SJ, Ji-Hwan H, Kyu SL. A comparison of holmium:YAG laser with lithoclast lithotripsy in ureteral calculi fragmentation.Int Jr of Urol 2005;12:544-7.
Tipu SA, Malik HA, Mohhayuddin N, Sultan G, Hussain M, Hashmi A, Naqvi SA, Rizvi SA.Treatment of ureteric calculi--use of Holmium: YAG laser lithotripsy versus pneumatic lithoclast.J Pak Med Assoc. 2007 Sep;57:440-3.
Satava RM. Identification and reduction of surgical error using simulation. Minim Invasive Ther Allied Technol 2005; 14:257-61.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240:205-13.
Dogan HS, Onal B, Satar N, Aygun C et al. Factors Affecting Complication Rates of Ureteroscopic Lithotripsy in Children: Results of Multi-Institutional Retrospective Analysis by Pediatric Stone Disease Study Group of Turkish PediatricUrology Society. J Urol 2011 ; 186 :1035-40.
Preminger GM, Tiselius HG, Assimos DG et al. Guideline for the management of ureteral calculi. Eur Urol 2007 ; 52: 1610-31.
Yapanoglu T, Aydın HR, Aksoy Y,Özbey I. Ureteroscopic management of distal ureteral stones in children: holmium:YAG laser vs. Pneumatic lithotripsy.Turk J Med Sci 2009 ;39:623-8. GMJ 2015; 26: