Cm In Children Research Articles

Systematic review of child maltreatment screening tools used by different occupational groups: a study protocol

BackgroundChild maltreatment (CM) encompasses physical, emotional or sexual abuse, physical or emotional/psychological neglect or intimate partner (or domestic) violence and is associated with adverse cognitive, behavioural, physical and social outcomes...

Inadequacy of a 12.5 cm MUAC as a cutoff for malnutrition for children aged three to five years

Introduction: MUAC (mid-upper arm circumference) is a simple and easily taught screening tool for identifying malnutrition in children. South Sudan use a MUAC of 12.5 cm for children aged between six months and five years as a cut-off for moderate acute malnutrition. Currently, in South Sudan, children from six months to five years have the same MUAC cutoff for malnutrition. Method: This study evaluated the sensitivity of using a MUAC of 12.5 cm as a screening tool for children between 6 and 60 months applied to data obtained from children enrolled in urban and rural primary schools in Maridi County, South Sudan. We used the 12.5 cm cutoff which was 2 standard deviations from the median for boys at nine months and for girls at 20 months. We also used 14.0 cm as the cutoff and compared the number of children identified, and also the false positive rate, assuming -2 SD from the median to be the accepted norm for malnutrition. Finally, we considered two different standards, using 14.0 cm for children aged 3-5 years and 12.5 cm for children under three years. Results: Comparing the results obtained using the two different MUAC standards (12.5 cm versus 14.0 cm) against a single MUAC standard there is a dramatic difference in outcome. Using the current standard (12.5 cm), only 7.3% of the children were found to be malnourished. Using 14.0 cm, 33.8 % were found to be malnourished (Table 4). If we accept the norm of 2 SD below the median for age as an adequate definition of malnutrition, the false positive rate using 14.0 cm is 9.6 %, an acceptable figure for a screening device, but the false negative rate for 12.5 cm is 17.4 %, a clearly unacceptable rate for a screening device. If, however, instead of using one cut-off for children from six months to five years, a period characterized normally by rapid growth and changes in body composition, we used two different standards—12.5 cm for those under three years and 14 cm for those aged 3-5 years, the number of false positives drops down to 2.7% and false negatives to 0.9 % Conclusion: We suggest that the use of 12.5 cm for malnourished children is inappropriate above two years, that 14 cm would be a more appropriate screening measurement from 3-5 years of age.

Medial End Clavicular Osteochondroma- An Unusual Case

Abstract Osteochondroma is the most common benign bone tumor, which could present as a sessile or pedunculated type and, in solitary or multiples, hereditary multiple exostoses (a genetic disorder, autosomal dominant inheritance). Clinical presentation is mostly asymptomatic, but if symptomatic, it presents in a wide spectrum, such as compression of adjacent vessels, nerves, deformities, fractures, bursa formation, and malignant transformation. Cancerous transformation is indicated by the thickness of the cartilage cap of >3 cm in children, >2 cm in adults, sudden onset of pain, and sudden/rapid growth of lesion (after growth plate closure). Surgical management is indicated for typical symptomatic lesions, complications, malignant transformation, and cosmetic reasons. The common treatment of choice is the excision of a tumor with a significant free margin.

Chest Compression Depth Targets in Critically Ill Infants and Children Measured With a Laser Distance Meter: Single-Center Retrospective Study From Japan, 2019-2022.

Current resuscitation guidelines recommend target chest compression depth (CCd) of approximately 4cm for infants and 5cm for children. Previous reports based on chest CT suggest these recommended CCd targets might be too deep for younger children. Our aim was to examine measurements of anterior-posterior chest diameter (APd) with a laser distance meter and calculate CCd targets in critically ill infants and children. A retrospective descriptive study. Single-center PICU, using data from May 2019 to May 2022. All critically ill children admitted to PICU and under 8 years old were eligible to be included in the retrospective cohort. None. The chest APd measurements using a laser distance meter are part of our usual practice on the PICU. Target CCd and the over-compression threshold CCd for each age group was calculated as 1/3 and 1/2 of APd, respectively. In 555 patients, the median (interquartile range) of the calculated target CCd for each age group was: 2.7 cm (2.5-2.9 cm), 2.9 cm (2.7-3.2 cm), 3.2 cm (3-3.5 cm), 3.4 cm (3.2-3.6 cm), 3.4 cm (3.2-3.6 cm), 3.6 cm (3.4-3.8 cm), 3.6 cm (3.4-4 cm), and 4 cm (3.5-4.2 cm), for 0, 2, 3-5, 6-8, 9-11, 12-17, 18-23, 24 to less than 60, and 60 to less than 96 months, respectively. Using guideline-recommended absolute CCd targets, 4 cm for infants and 5 cm for children, 49% of infants between 0 and 2 months, and 45.5% of children between 12 and 17 months would be over-compressed during cardiopulmonary resuscitation. In our cohort, the 1/3 CCd targets calculated from APd measured by laser meter were shallower than the guideline-recommended CCd. Further studies including evaluating hemodynamics during cardiopulmonary resuscitation with these shallower CCd targets are needed.

In the Treatment of Lower Pole Kidney Stones Between 1-2 cm in Children, Which is the Best Approach? Retrograde Intrarenal Surgery or Mini Percutaneous Nephrolithotomy.

Kidney stones are treated with many methods, but there is no consensus on which method should be preferred for 1-2 cm lower renal stones. In our study, we aimed to investigate the results of mini (Percutaneous Nephrolithotomy) PCNL and (Retrograde Intrarenal Surgery) RIRS in lower renal pole 1-2 cm stones. Twenty-four mini PCNL and 55 RIRS patients were included in the study. Demographic data of the patients and information about stones on Non-Computed Tomography (NCCT) were recorded. Stone-free status (SFR), need for additional treatment and complications of both methods were compared. Operative time was 55.2±20.8 min in mini PCNL and 70.7±36.5 min in RIRS, which was statistically significantly lower (p=0.002). Length of hospital stay was 2.4±1.5 days in the mini PCNL and 1.3±0.7 days in the RIRS, which was statistically significantly longer (p=0.011). In the postoperative 1st month and 3rd month stone-free rates (SFR) were higher in the mini PCNL group. While the 1st month SFR was 91.6% and 54.5%, the 3rd month stone-free rates were 95.8% vs. 69.1%, respectively (p<0.001). The need for re-treatment was statistically lower in the mini PCNL group (p<0.001). In terms of complications, the incidence of complications was 16.6% (pain in 2 patients, fever in 1 patient, need for blood transfusion in 1 patient) in the mini PCNL group and 21.8% (pain in 2 patients, fever in 8 patients, sepsis in 2 patients) in the RIRS group. There was a significant difference between the two groups (p=0.008). Mini PCNL has a higher SFR, less need for re-treatment and fewer complications.

Common Complications of Mini PCNL in Renal Stones more than 3.0 cm

Mini PCNL (mPCNL) procedures now often employ miniature nephroscopes that were originally created to treat paediatric kidney stones. There is scarcity of knowledge regarding complications of mPCNL in renal stones larger than 3 cm. Objective: To determine the common complications of mini PCNL performed for renal stones larger than 3.0cm. Methods: This descriptive case series study was conducted over a period of one year from November 2022 to October 2023 registered patients aging 4 to 14 years undergoing mPCNL with renal stones &gt;3cm. The patients underwent mini PCNL and patients were followed over a period of 4 weeks for early (occurring within 48 hours of procedure) and late complications (occurring after 48 hours). Results: A total of 86 cases were analyzed. The age of the participants ranged from 4 years to 14 years. The mean age of the patients was 9.19±2.49 years. Majority of the participants were in the age group 10-14 years 57 (66.3%). Male to female ratio was 1.2: 1. Among the early complications, the most commonly reported was post-pain reported by 24 (28.0%) patients, followed by hematuria in 15(17.4%). Surgical site infection was the most common late complications observed in 9 patients (10.4%) followed by re-do surgery for 2 patients (2.3%) and none of the patient suffered renal dysfunction among our participants. Conclusions: MPCNL can be offered as a safe and secure surgical option with excellent results and manageable side effects for treating nephrolithiasis larger than 3cm in children.

Poor Concordance of One-Third Anterior-Posterior Chest Diameter Measurements With Absolute Age-Specific Chest Compression Depth Targets in Pediatric Cardiac Arrest Patients.

Background Current pediatric cardiac arrest guidelines recommend depressing the chest by one-third anterior-posterior diameter (APD), which is presumed to equate to absolute age-specific chest compression depth targets (4 cm for infants and 5 cm for children). However, no clinical studies during pediatric cardiac arrest have validated this presumption. We aimed to study the concordance of measured one-third APD with absolute age-specific chest compression depth targets in a cohort of pediatric patients with cardiac arrest. Methods and Results This was a retrospective observational study from a multicenter, pediatric resuscitation quality collaborative (pediRES-Q [Pediatric Resuscitation Quality Collaborative]) from October 2015 to March 2022. In-hospital patients with cardiac arrest ≤12 years old with APD measurements recorded were included for analysis. One hundred eighty-two patients (118 infants >28 days old to <1 year old, and 64 children 1 to 12 years old) were analyzed. The mean one-third APD of infants was 3.2 cm (SD, 0.7 cm), which was significantly smaller than the 4 cm target depth (P<0.001). Seventeen percent of the infants had one-third APD measurements within the 4 cm ±10% target range. For children, the mean one-third APD was 4.3 cm (SD, 1.1 cm). Thirty-nine percent of children had one-third APD within the 5 cm ±10% range. Except for children 8 to 12 years old and overweight children, the measured mean one-third APD of the majority of the children was significantly smaller than the 5 cm depth target (P<0.05). Conclusions There was poor concordance between measured one-third APD and absolute age-specific chest compression depth targets, particularly for infants. Further study is needed to validate current pediatric chest compression depth targets and evaluate the optimal chest compression depth to improve cardiac arrest outcomes. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02708134.

Is Triple D Score Effective to Predict the Stone-Free Rate After Shockwave Lithotripsy in Pediatric Population.

Triple D score was developed using skin-to-stone distance, stone density, and stone volume for prediction of extracorporeal shockwave lithotripsy (SWL) outcomes in adults. SWL is the first-line treatment method for kidney stones smaller than 2 cm in children however it was not validated in pediatric population. The present paper aims to validate Triple D score in pediatric patients. Of the 269 children treated with SWL between 2007 and 2021, a total of 147 children who had adequate follow-up data and evaluated with non-contrast computed tomography before SWL, were included in the study. Parameters were calculated for each of the stone volume (SV), skin-to-stone distance (SSD), and stone density (SD) variables. Receiver operator characteristic analysis was used to set cut-off values. Triple D scores were calculated, and success rates were determined for each score. Stone-free status was determined as complete clearance after three months of final SWL. The median age of the study group was 7 (range 1 to 16). Ninety-three of the 147 (63%) children had stone-free status. Mean SV, SSD and SD values were significantly higher in SWL failed group than stone-free group after detecting cutoff values of 155 mm3, 6.5 cm, and 550 HU, respectively. Stone-free rates were detected as 23.8%, 35.1%, 74.0%, and 92.0% with the Triple D scores of 0, 1, 2, and 3 points. Our study confirms that Triple D scores supports the SWL outcomes in pediatric population. We believe that our research on Triple D score validation in children is of great clinical importance although various factors may affect to predict the success of SWL.

Optimal Positioning of Nasopharyngeal Temperature Probes in Infants and Children: A Prospective Cohort Study.

The nasopharynx is an easily accessible core-temperature monitoring site, but insufficient or excessive nasopharyngeal probe insertion can underestimate core temperature. Our goal was to estimate optimal nasopharyngeal probe insertion depth as a function of age. We enrolled 157 pediatric patients who had noncardiac surgery with endotracheal intubation in 5 groups: (1) newborn to 6 months old, (2) infants 7 months to 1 year old, (3) children 13 to 23 months old, (4) children 2 to 5 years old, and (5) children 6 to 12 years old. A reference esophageal temperature probe was inserted at an appropriate depth based on each patient's height. A nasopharyngeal temperature probe was inserted from the naris at 10 cm in newborn and infants, 15 cm in children aged 1 to 5 years old, and 20 cm in children who were 6 years or older. The study nasopharyngeal probes were withdrawn 1, 2.5, or 2 cm (depending on age) 10 times at 5-minute intervals. Optimal probe insertion distances were defined by limits of agreement (LOAs) between nasopharyngeal and esophageal temperatures <0.5 °C. Optimal nasopharyngeal temperature probe position ranged from 6 to 10 cm in infants up to 6 months old, 7 to 8 cm in infants 7 to 12 months old, 7.5 to 12 cm in children 13 to 23 months old, and 10 to 12 cm in children aged 6 years and older. The 95% LOAs were <0.5 °C for all age categories except the 2- to 5-year-old group where the limits extended from -0.67 °C to 0.52 °C at 9 cm. At the optimal position within each age range, the bias (average nasopharyngeal-to-esophageal temperature difference) was ≤0.1 °C. Nasopharyngeal thermometers accurately measure core temperature, but only when probes are inserted a proper distance, which varies with age. As with much in pediatrics, nasopharyngeal thermometer insertion depths should be age appropriate.

The long-term growth, cost-effectiveness, and glycemic effects of growth hormone therapy on children born small for gestational age over 10years: a retrospective cohort study.

We aimed to report our 10-year experience of treating short children born small for gestational age (SGA) by comparing the long-term growth, metabolic safety, and cost-effectiveness of recombinant human growth hormone (rhGH) therapy in short children born SGA with those in rhGH-treated children with growth hormone deficiency (GHD) and Turner syndrome. We performed a 10-year retrospective cohort study at King Saud University Medical City. We included children aged 3-16years who received rhGH for GHD, SGA, or Turner syndrome for >1year. A total of 166 children received rhGH therapy for GHD, 58 for SGA, and 16 for Turner syndrome. During the last study visit, the average height change was 21cm for GHD children and 14cm for children born SGA (p-value <0.001). The height SDS change was 0.84 forGHD children and 0.55 for SGA children (p-value=0.004). The average cost-effectiveness ratios for treating GHD and SGA children were USD 1,717.22 and USD 1,157.19 per centimeter gained, respectively. Moreover, the mean incremental cost-effectiveness ratio for GHD vs. SGA patients was USD 2,820.39 per centimeter gained. Dysglycemia developed in 70 patients: 43 (36.44%), 22 (40.74%), and 5 (13%) in the GHD, SGA, and Turner syndrome groups, respectively. rhGH is effective in height improvement of short children. However, pursuing rhGH treatment for children born SGA requires a shared decision-making approach to balance the modest benefit of final adult height gain with the long-term metabolic effects, considering the acceptable costs on the Saudi healthcare system.

ANATOMICAL RATIONALE FOR CHOOSING A BLADE FOR POWER-ASSISTED ADENOIDECTOMY IN CHILDREN DEPENDING ON DENTITION.

The aim: To study the anatomic features of the facial skull structures in children of various ages depending on dentition. Materials and methods: One hundred and forty-four children aged 2-12 years were divided into 4 groups depending on dentition. They underwent anthropometric measure¬ments during adenoidectomy. Based on the cosine theorem, the calculated values were obtained. Results: The distance from choana to the free edge of the retracted soft palate gradually increases from 2.01±0.61 cm in children with stable primary dentition up to 3.09±1.02 cm with mixed dentition. Palato-nasopharyngeal angle in children with stable primary dentition is 126.25±8.76°, in children with aging primary dentition - 132.81±12.21°, and in children with mixed dentition - 120.54±13.72°. Conclusions: The optimal configuration of the blade for power-assisted adenoidectomy in children with stable primary dentition has an angle of 53.53±8.76°, and the length of the working part of 2.01±0.61 cm, in children with aging primary dentition - 47.18±12.21° and 2.10±0.71 cm, with mixed dentition - 59.45±13.72° and 3.09±1.02 cm, respectively.

Nonalcoholic fatty liver disease-related hepatocellular carcinoma growth rates and their clinical outcomes.

Aim:Nonalcoholic fatty liver disease (NAFLD)-associated hepatocellular carcinoma (HCC) is projected to become the leading indication for liver transplantation. Previous studies indicate that tumor growth rates (TGR) may predict survival and were helpful in determining HCC surveillance intervals. Therefore, we aimed to determine its usefulness in predicting clinical outcomes and treatments.Methods:We conducted a retrospective study of hepatitis B, C and NAFLD-HCC cases. TGR was measured using 2-consecutive pre-treatment contrast-enhanced imaging studies ≥ 25 days apart. A multivariate regression model was used to determine predictors of TGR. In addition, the Cox regression model was used to evaluate the relationship between TGR and overall survival.Results:From 2000–2019, the study cohort comprised 38, 60, and 47 HBV, HCV, and NAFLD patients, respectively, with TGRs. NAFLD-HCC tumor size was inversely correlated to the extent of liver disease as measured by Child-Pugh score (7.2 cm in non-cirrhosis; 3.7 cm, 2.6 cm, and 2.1 cm in Child A, B, and C, respectively; P < 0.001). After adjusting for baseline characteristics, the TGR per month was fastest in HBV (9.4%, 95%CI: 6.3%-12.5%) compared to HCV (4.9%, 95%CI: 2.8%-7%) and NAFLD patients (3.6%, 95%CI: 1.6%-6.7%). Predictors of TGR included elevated AFP, low albumin, and smaller tumor size. Fast TGR in viral etiologies had higher mortality [adj. hazard ratio (HR) = 2.6, 95%CI: 1.2–5.7, P = 0.02] than slow TGRs, independent of treatments. Fast TGR in NAFLD had a trend towards higher mortality (HR = 3.6, 95%CI: 0.95–13.3, P = 0.059).Conclusion:NAFLD-HCC patients have more indolent growths than viral-related HCC TGRs. The addition of TGR as a biomarker may assist in stratifying treatment options.

Re: Guler Y, Erbin A. Comparison of extracorporeal shockwave lithotripsy and retrograde intrarenal surgery in the treatment of renal pelvic and proximal ureteral stones ≤2 cm in children. Indian J Urol 2020;36:282-7.

Re: Guler Y, Erbin A. Comparison of extracorporeal shockwave lithotripsy and retrograde intrarenal surgery in the treatment of renal pelvic and proximal ureteral stones ≤2 cm in children. Indian J Urol 2020;36:282-7.

Author reply Re: Guler Y, Erbin A. Comparison of extracorporeal shockwave lithotripsy and retrograde intrarenal surgery in the treatment of renal pelvic and proximal ureteral stones ≤2 cm in children. Indian J Urol 2020;36:282-7.

Author reply Re: Guler Y, Erbin A. Comparison of extracorporeal shockwave lithotripsy and retrograde intrarenal surgery in the treatment of renal pelvic and proximal ureteral stones ≤2 cm in children. Indian J Urol 2020;36:282-7.

Achievable dose reductions with gonadal shielding for children and adults during abdominal/pelvic radiographic examinations: A Monte Carlo simulation

Recently, medical professionals have reconsidered the practice of routine gonadal shielding for radiographic examinations. The objective of this study was to evaluate the gonadal dose reduction achievable with gonadal shields in the primary beam during abdominal/pelvic radiographic examinations under ideal and non-ideal shielding placement. CT scans of CIRS anthropomorphic phantoms were used to perform voxelized Monte Carlo simulations of the photon transport during abdominal/pelvic radiographic examinations with standard filtration and 0.1mm Cu+1mm Al added filtration to estimate gonadal doses for an adult, 5yr old, and newborn phantom with and without gonadal shields. The reduction in dose when the shields were not placed at the ideal locations was also evaluated. The ratio of the number of scattered-to-primary photons (SPR) across the anteroposterior (AP) dimension of the phantoms was also reported. The simulated dose reduction with ideal shielding placement for the testes and ovaries ranged from 80% to 90% and 55% to 70% respectively. For children, a misalignment of the shield to the gonad of 4cm reduced the measured dose reduction to the gonads to <10%. For adults, this effect did not occur until the misalignment increased to ~6cm. Effects of dose reduction with and without the gonadal shields properly placed were similar for standard filtration and added filtration. SPR at the level of the testes was consistently <1 for all phantoms. SPR for ovaries was ~1.5 for the adult and 5-yr old, and ~1 for the newborn phantom. Dose reduction with ideal alignment of the simulated gonadal shield to the gonads in this study was greater for the testes than the ovaries; both reductions were substantial. However, the dose reductions were greatly reduced (to <10%) for both sexes with misalignment of the gonads to the shields by 4cm for children and 6cm for adults.

Increased risk for child maltreatment in those with developmental disability: A primary health care perspective from Israel

BackgroundChild Maltreatment (CM) is a worldwide phenomenon. Literature suggests that children with disabilities are at increased risk for CM. However, limited information exists regarding if such increased risk is noted in community primary care clinics. AimTo report on the incidence of CM in children with and without disabilities attending community primary care clinics. MethodThis was a cohort study of children belonging to a Health Maintenance Organization (HMO) in Israel. The study group consisted of children with disabilities and the control group consisted of children without disabilities. Formal reports to child protection services, medical and sociodemographic data were extracted from designated documentation and medical records. ResultsThe odds to be identified as suspected CM, after adjusting for sociodemographic variables, was 6.2 times higher among children with disabilities compared to children without disabilities and 5.0 times higher among children with severe vs. mild disability. ConclusionsDevelopmental disability is a risk factor for CM, and is noted even more seriously in community primary care clinics. CM positively correlated with the severity of disability. The presented data marks higher figures than previously reported, enhancing understanding of the scope of the problem and its relation to the type of organization being examined.

Results from a Genome-Wide Association Study (GWAS) in Mastocytosis Reveal New Gene Polymorphisms Associated with WHO Subgroups.

Mastocytosis is rare disease in which genetic predisposition is not fully understood. The aim of this study was to analyze associations between mastocytosis and single nucleotide polymorphisms (SNPs) by a genome-wide association study (GWAS) approach. A total of 234 patients were enrolled in our study, including 141 with cutaneous mastocytosis (CM; 78 children and 63 adults) and 93 with systemic mastocytosis (SM, all adults). The control group consisted of 5606 healthy individuals. DNA samples from saliva or blood were genotyped for 551 945 variants using DNA microarrays. The prevalence of certain SNPs was found to vary substantially when comparing patients and healthy controls: rs10838094 of 5OR51Q1 was less frequently detected in CM and SM patients (OR = 0.2071, p = 2.21 × 10−29), rs80138802 in ABCA2 (OR = 5.739, p = 1.98 × 10−28), and rs11845537 in OTX2-AS1 (rs11845537, OR = 6.587, p = 6.16 × 10−17) were more frequently detected in CM in children and adults. Additionally, we found that rs2279343 in CYP2B6 and rs7601511 in RPTN are less prevalent in CM compared to controls. We identified a number of hitherto unknown associations between certain SNPs and CM and/or SM. Whether these associations are clinically relevant concerning diagnosis, prognosis, or prevention remains to be determined in future studies.

Pediatric cardiopulmonary resuscitation quality during intra-hospital transport

AimTo evaluate pediatric cardiopulmonary resuscitation (CPR) quality during intra-hospital transport to facilitate extracorporeal membrane oxygenation (ECMO)-CPR (ECPR). We compared chest compression (CC) rate, depth, and fraction (CCF) between the pre-transport and intra-transport periods. MethodsObservational study of children <18 years with either in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) who underwent transport between two care locations within the hospital for ECPR and who had CPR mechanics data available. Descriptive patient and arrest characteristics were summarized. The primary analysis compared pre- to intra-transport CC rate, depth, and fraction. A secondary analysis compared the proportion of pre- versus intra-transport 60-s epochs meeting guideline recommendations for rate (100–120/min), depth (≥4 cm for infants; ≥5 cm for children ≥1 year), and CCF (≥0.80). ResultsSeven patients (four IHCA; three witnessed OHCA) met eligibility criteria. Six (86%) patients survived the event and two (28%) survived to hospital discharge. Median transport CPR duration was 7 [IQR 5.5, 8.5] minutes. There were no differences in pre- vs. intra-transport CC rate (115 [113, 118] vs. 118 [114, 127] CCs/minute; p = 0.18), depth (3.2 [2.7, 4.4] vs. 3.6 [2.5, 4.6] cm; p = 0.50), or CCF (0.89 [0.82, 0.90] vs. 0.92 [0.79, 0.97]; p = 0.31). Equivalent proportions of 60-s CPR epochs met guideline recommendations between pre- and intra-transport (rate: 66% vs. 57% [p = 0.22]; depth: 14% vs. 19% [p = 0.39]; CCF: 80% vs. 75% [p = 0.43]). ConclusionsPediatric CPR quality was maintained during intra-hospital patient transport, suggesting that it is reasonable for ECPR systems to incorporate patient transport to facilitate ECMO cannulation.

Miniature semi-rigid ureteroscopy with holmium-yttrium-aluminium-garnet laser vs shockwave lithotripsy in the management of upper urinary tract stones >1 cm in children

ABSTRACT Objective To compare the efficacy and safety of miniature semi-rigid ureteroscopy (URS) with holmium (Ho)-yttrium-aluminium-garnet (YAG) laser lithotripsy vs shockwave lithotripsy (SWL) for treating upper urinary tract (UUT) calculi >1 cm in children. Patients and methods Children with unilateral single UUT ureteric stones of >1 cm were prospectively enrolled in this study. Patients were randomly divided into two groups: Group 1, treated with SWL; and Group 2, treated with URS (6/7.5 F) and laser lithotripsy. The patients’ characteristics, stones demographics, operative time, adjunctive procedures, stone-free rate (SFR), re-treatment rate, and complications were statistically analysed and compared. Success was defined as stone-free status (no stone residual of ≥0.3 cm) at 1 month from the initial treatment without any auxiliary procedures. Results In all, 68 patients with UUT stones met our inclusion criteria. There were no significant differences between the two groups for patient or stone demographics. In Group 1, the SFR was 26/34 (76.4%) and in Group 2 it was 33/34 (97.1%) (P = 0.03). A total of 12 auxiliary procedures in Group 1 and two in Group 2 were needed to reach a 100% SFR (P = 0.014). There were no significant differences between the two groups for operative times, adjunctive procedures, number of complicated cases or complications of Grade ≥III (P = 0.65, P = 0.23, P = 0.77, and P = 0.62, respectively). Conclusion Miniature semi-rigid URS with Ho-YAG laser lithotripsy for UUT ureteric stones of >1 cm in children was more effective than SWL in terms of SFR and re-treatment rate, with no significant difference in the rate or grade of complications. Abbreviations EQ: efficiency quotient; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; RCT: randomised controlled trial; SFR: stone-free rate; SWL: shockwave lithotripsy; URS: ureteroscopy; US: ultrasonography/ultrasound; URS: ureteroscopy; UUT: upper urinary tract; YAG: yttrium-aluminium-garnet

Comparison of extracorporeal shockwave lithotripsy and retrograde intrarenal surgery in the treatment of renal pelvic and proximal ureteral stones ≤2 cm in children.

Introduction:We aimed to compare extracorporeal shockwave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS) in pediatric patients with ≤2 cm renal pelvis and proximal ureteral stones.Methods:Medical records of 165 pediatric patients who underwent shockwave lithotripsy (SWL) or RIRS for upper urinary system stones up to 2 cm between January 2014 and December 2018 were retrospectively reviewed. After exclusions, the remaining 130 patients included 73 in the SWL group and 57 in the RIRS group. The groups were compared for demographic features, stone characteristics, operative data, success, and complications.Results:The mean stone volume was 308 ± 85 (54–800) and 336 ± 96 (60–720) mm3 in SWL and RIRS groups, respectively (P = 0.46). There were no significant differences in success rates (60% vs. 70%, SWL and RIRS), auxiliary treatment rates (16.4% vs. 14%), and complication rates (26% vs. 24.5%). The number of active procedural sessions and number of anesthesia sessions was higher in the RIRS group (P < 0.001 and P < 0.001, respectively), while the procedural time and anesthesia time were higher in the SWL group (P < 0.001 and P < 0.001, respectively). Stone size was found to be an independent success predictive factor for both the treatment modalities.Conclusions:Both SWL and RIRS have similar success, complication, and auxiliary treatment rates. RIRS was superior in terms of total procedure and anesthesia durations, while SWL was superior in terms of numbers of anesthesia sessions and active procedure sessions. As both have similar success rates, the more minimally invasive SWL should be chosen for pediatric upper urinary system stones of less than 2 cm size.