Endoscopic Treatment of Lower Urinary Tract Stones in Children

Abstract

Eighty children suffering from l(nver unnary tract urolithiasis (twenty

patients with distal ureteral calculi, fourty patients with vesical calculi and twenty patients with urethral calculi) were treated endoscopically in the department of urology, Assiut University Hospital over a period of two years from March 1995 through March 1997. All were subjected to history taking, clinical examination. routine laboratory and radiological investigations. Males constituted 80'% of cases. Recurrent stones represented 17.5'% of cases. Ureteroscopy was done for all cases presented with distal ureteral calculi (20 cases). The stone bmden ranged from 6-12 mm. Dilatation of the meleric orifice ;:mel intramural ureter maximally up to 12 F was done under fluoroscopic control. In

5 cases the ureteroscopy was done without preliminary dilatation. Stone extraction was done in I I cases, intraureterallithotripsy was done in 8 cases (USD in 5 cases and EHL in 3 cases). Ureteric stents (D..I. stent in 6 cases and ureteric catheter in 14 cases) were inserted at the end of the manoeuver. Successful stone retrieval was obtained in 95%. Failure occurred only in one case because of upward migration of the stone. EHCL done for all c"ses presented with vesical and urethr"l calculi which were returned b"ck to the urinary bladder. EH probe size "nd peak energy delivered to the calculus varied according to the average stone bmden and stone composition. After complete disintegrntion, a urethral catheter was fixed i11 50 cases for one clay only. The procedure ended without fixation of urethral catheter in other I 0 cases. Successful disintegration occurred in 96. 7'%. Failure occurred in 2 cases, one due to incomplete disintegration and the other case due to intraperitoneal bladder perforation.