Flexible ureteroscopy and holmium laser lithotripsy for chileren and infants with upper urinary stones: single-center experience of 92 cases

Abstract

Objective To evaluate the efficiency and safety of flexible ureteroscopy (FURS) and holmium laser lithotripsy for children and infants with upper urinary stones. Method 92 children or infants patients with upper urinary stones were treated with FURS and holmium laser lithotripsy at our hospital from June 2014 to August 2015. Of 92 patients, 69 were male and 23 were female, mean age was 42 months (4-168 months). Mean stone size was 1.4 cm (0.6-3.0cm). All patients should be indwelled double J stent of F 4.7 two weeks in advance and intravenous antibiotics were administered two days before operation. After induction of general anesthesia using a laryngeal mask for airway management. Without inserting the ureteral access sheath, a trocar was used to perform a suprapubic puncture cystostomy to allow drainage. Explore the ureter and renal pelvis with the flexible ureteroscope and disrupt the stone with holmium laser as much as possible until the diameter of the fragments was <4 mm. The power of laser was maintained ranged from 18W to 32W. Extract the larger residual stone with a nitinol basket if necessary. A double J stent was left in place for 4 weeks in all cases routinely. Results 121 cases of operations was successfully performed in these 92 patients, with the average operative time of 25 min (range 15 to 60 min). 85 patients were stone-free by one-stage operation, 7 patients treated by one-stage operation at 6-month of follow up. 62 cases of slight transient hematuria after postoperation, 10 cases got fever (temperature<38.5℃), 8 cases of postoperative fever more than 39℃, getting improvement after symptomatic treatment after, 1 case of perfusion fluid extravasation in perirenal and pelvic. No other serious complications in all cases. Conclusions Flexible ureterscopy(FURS) and holmium laser lithotripsy has higher stone-Free rate (SFR) and clinical safety for upper urinary stones. This surgical treatment is a reliable choice for infants and children with upper urinary stones. Key words: Children; Infants; Upper urinary stones; Flexible ureteroscopy; Holmium laser