Ureteral Stones In Children Research Articles

Safety and feasability of ureteroscopy for pediatric stone, in children under 5 Years (SFUPA 5): A French multicentric study

Ureteroscopy (URS) can be proposed as first-line therapy for the management of pelvic stones from 10 to 20mm and for lower ureteric stones in children. However, little is known about the success and the morbidity of URS in young children. Ureteroscopic treatment may present matters in young children because of the small size of the pediatric kidney and the small size of the collecting system. To assess safety and efficacy of URS for the treatment of urinary stones in children aged of 5 years or less. After the institutional ethical board approval was obtained, we conducted a retrospective, analytic, multicentric study that included all URS performed between January 2016 and April 2022 in children aged of 5 years or less. In this non-comparative case series, anonymized pooled data were collected from 7 tertiary care centers of pediatric patients. Endpoints were the one-session SFR at 3 months and per and postoperatives complications. Descriptive statistics were applied to describe the cohort. Eighty-three patients were included. For them, 96 procedures were performed at the median age of 3.5 years (IQR: 0.8-5) and median weight of 14Kg (6.3-23). Median stone size was 13mm (4-45). There were 65 (67 %) renal stones treated with flexible URS, most of which were in the renal pelvis (30 %) and in the lower calix (33 %). A ureteral access sheath was used in 91% procedures. Preoperative ureteral stent was placed in 52 (54 %) of patients. None of patients had ureteral dilatation. The single-session SFR was 67.4 % (56.3 and 89.2% for flexible URS and semi-rigid URS respectively) and children require 1.4 procedures to achieve complete stone clearance. The overall complication rate was 18.7 %, most of them were minor (Clavien I-II). Intraoperative perirenal extravasation (Clavien IIIb) due to forniceal rupture was documented in 6.2% of cases, related to an increased intrapelvic pressure (IPP) performed in a closed pelvicalyceal system. Pediatric urologists should be aware of forniceal rupture based on the presence of extravasation of contrast during endourological procedures especially when they have difficulties to reach lower caliceal stone in small patient. URS in patients aged of 5 years or less, is a complex minimally invasive procedure with reasonable efficacy and low morbidity. Intrarenal stones treated by RIRS in young children carries the risk of additional procedures to complete stone clearance.

Standardization of the management of pediatric urolithiasis in the emergency department

The incidence of urolithiasis in the pediatric population is rising and medical expulsive therapy (MET) using alpha-adrenergic antagonists has been found to be effective in aiding in the passage of ureteral stones in children. A prior review of patients presenting to our quaternary children's hospital with urolithiasis found only 54% were prescribed MET and these patients had increased rates of spontaneous stone passage. Thus, an ED urolithiasis management protocol was created to standardize evaluation and care of children with suspected urolithiasis. To compare management of children with urolithiasis presenting to the ED before and after urolithiasis management protocol implementation. This is a retrospective review of patients with urolithiasis who presented to our children's ED from 2011 to 2022. The primary outcome was rate of MET prescribing before and after pathway implementation in July 2017, thus the pre-implementation group comprises patients who presented to the ED from July 2011 to July 2017, and the post-protocol group includes those who presented from August 2017 to April 2022. Secondary outcomes included CT utilization in the ED, surgical intervention rate, proportion with spontaneous stone passage, and frequency of urology consultation. Two-sample t-test and Fisher's exact test were used to compare the outcomes of interest before and after protocol implementation. Of 337 patients who presented to the ED after protocol implementation, 120 met inclusion criteria. When comparing outcomes before and after implementation of the protocol, there was significantly decreased use of CT scans (79% vs 50%, p<0.0001) and increased prescribing of MET (54% vs 82%, p<0.0001). There was a significant decrease in opioids prescribed (44% vs 26.7%, p=0.0040), and an increased rate of spontaneous stone passage (34% vs 46%, p=0.0483). Lastly, there was a significant reduction in the rate of surgery for stone management after the implementation of protocol (35% vs 17%, p=0.0020) DISCUSSION: As the ED is the primary site of presentation for many children with urolithiasis, standardization of evaluation and management provides an opportunity to improve outcomes in this population. We found that implementation of an ED urolithiasis management protocol was associated with decreased use of CT scans, decreased opioid prescribing, increased spontaneous stone passage, and decreased rate of surgical management for children with ureteral stones. This study demonstrates the positive impact of standardizing care for children presenting to the ED with urolithiasis.

A Novel Technique of Management of Impacted VUJ Calculus: Laparoscopic Ureterotomy

The incidence of urolithiasis in the pediatric population is on the rise. Endoscopic lithotripsy has become a technique of choice for the treatment of ureteral stones in children. Laparoscopic ureterolithotomy is a minimally invasive option for ureteric stones that are not amenable to ureteroscopy. We present a case of 7 years girl with right impacted vesicoureteric junction (VUJ) calculus with bullous cystitis managed innovatively with laparoscopic ureterotomy.

Comparing the efficacy of extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy in the treatment of proximal ureteral stones in children: A retrospective study.

Ureteroscopic lithotripsy and extracorporeal shock wave lithotripsy methods are commonly used in the treatment of proximal ureteral stones. There are no adequate studies showing which method is more effective in children. In our study, we aimed to evaluate and compare the efficacy of two treatment methods, commonly used for proximal ureteral stones in children. A total of 78 patients who underwent ureteroscopic lithotripsy (n = 38) and extracorporeal shock wave lithotripsy (n = 40) due to stones located in the proximal ureter between 2010 and 2021 were included in the study. Demographic data, clinical characteristics, and treatment outcomes were retrospectively analyzed. Kolmogorov-Smirnov, Chi-square, and Mann-Whitney U tests were used for statistical analysis. There was no statistical difference between the demographic characteristics of the groups, except for the mean age values (p = 0.008). A statistically significant difference was found in favor of the extracorporeal shock wave lithotripsy group in terms of stone-free rates after the first intervention, complication rates requiring intervention, re-intervention rates, and the average number of anesthesia sessions per patient until stone-free status (p = 0.043, p = 0.009, p = 0.017, and p < 0.001, respectively). The results of this retrospective study suggest that extracorporeal shock wave lithotripsy is the primary treatment option for single, non-complicated proximal ureteral stones.

Investigating ESWL success rate in the treatment of renal and ureteral stones in children.

Extracorporeal shock wave lithotripsy (ESWL) is one of the most important methods of treatment for stone in children. Therefore, this study was conducted to determine the success rate of ESWL in the treatment of kidney and ureteral stones in children referred to Hasheminejad kidney center during the second half of 2018. This observational prospective study was conducted on 144 children referred to Hasheminejad kidney center during the 2018. The patients were selected using the convenience sampling method. The study was investigating the success rate of ESWL in the treatment of kidney and ureteral stones and effective factors in this regard. A total of 133 patients (92.4%) had stone passage and 37.5% of patients had residual stones, 28.5% of which were less than 5 mm in diameter. Successful results were seen in 131 cases (91%). Successful results were significantly higher in males (p = 0.011) and lower in simultaneous stones in the middle calyx and lower calyx (p = 0.0001). According to the results of this study, it can be inferred that ESWL success rate was above 90% in the treatment of kidney and ureteral stones in children in such a way that with an ESWL session in patients who have been properly selected for this procedure, a success rate of about 62.5% will be available to remove any residual fragments, and nearly 28.5% have residual fragments with a diameter of smaller than 5 mm, which is basically hopeful for a high urinary passage. The present study shows that type and stone location are the factors contributing to the successful ESWL and shows the female gender and the presence of stone in the lower and middle calyx are the risk factors for the lower ESWL success rate.

Complication rate after pediatric shock wave lithotripsy according to Clavien-Dindo grading system: results from a systematic review and meta-analysis of the existing literature.

Shockwave lithotripsy (SWL) is a minimally invasive technique utilized for renal and ureteric stones in children. Despite being considered safe, certain complications have been recorded. We performed this systematic review and meta-analysis to provide a pooled analysis of Clavien-Dindo graded complications after SWL in children. MEDLINE/PubMed, Scopus and Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, were screened from inception to 12/02/2022 by two authors independently. Only randomized controlled trials providing Clavien-Dindo classification or relevant clinical information were considered eligible. Overall complications were calculated using the aggregate number of each complication divided by the total number of patients in studies with data. Pooled analysis revealed that from children treated with SWL, 27.7% [95% CI 13.1-49.4] suffered Clavien I complications, 4.9% [95% CI 3.1-7.6] Clavien II complications, 2.7% [95% CI 1.6-4.7] Clavien III complications, 2.3% [95% CI 1.3-4] Clavien IV complications, while no Clavien V complications were recorded. In total, 28.1% [95% CI 15.6-45.3] of children suffered minor complications (Clavien-Dindo I-II), while 3% [95% CI 1.8-5] major complications (Clavien-Dindo III-V). Pooled analysis revealed that 10.7% [95% CI 3.2-30.1] of patients suffered macroscopic hematuria, 7.3% [95% CI 2.1-22.7] pain, 5.5% [95% CI 3.3-9] steinstrasse, 5.3% [95% CI 3-9.3] fever, 2.2% [95% CI 0.8-5.6] sepsis, 1.1% [95% CI 0.3-3.7] urinoma, 1% [95% CI 0.4-2.7] symptomatic hematoma and 1% [95% CI 0.3-2.7] asymptomatic hematoma. Need for re-treatment was 42.6% [95% CI 31.4-54.7] and need for auxiliary procedures was 11.8% [95% CI 8.5-16.1]. SWL is an irreplaceable tool for treating urolithiasis in children. Although a minimally invasive technique, parents and children should be adequately informed about the risk of minor/major complications.

Absolute White Blood Cell Count and Neutrophil-Lymphocyte Ratio May Predict the Need for Double- J Stent Insertion in Ureteral Stones in Children: A Comparative Study

Absolute White Blood Cell Count and Neutrophil-Lymphocyte Ratio May Predict the Need for Double- J Stent Insertion in Ureteral Stones in Children: A Comparative Study

Comparative analysis of ureteroscopic laser lithotripsy and extracorporeal shock wave lithotripsy in the treatment of childhood proximal ureteral stones

This study aims to make a comparative analysis of the superiority of ESWL and URS in proximal ureteral stones in children. A total of 155 patients under the age of 15 were included in the study. The patients were divided into two groups as Group 1 (n = 80, ESWL) and Group 2 (n = 75, URS) according to the type of procedure performed. The patients in both groups were evaluated in terms of age, gender, lateralization, stone size, stone volüme, stone density, and preoperative hydronephrosis. In addition, both methods used were compared in terms of success rate, time, cost, hospitalization and complications. The mean age were 7.4 ± 2.1 in Group-1 and 8.1 ± 1.8 in Group-2. Demographic, clinical and laboratory data of both groups were similar. The hospitalization time, procedure time, success rate and cost were significantly higher in Group-2. The complication rate was significantly higher in Group-2 (p < 0.001). There was a significant negative correlation between ESWL success and stone volume (ρ -0.375, p = 0.001) and stone density (ρ -0.283, p = 0.011). ESWL can be performed as the first line treatment of proximal ureteral stones in children due to its daily use, low cost, short procedure time and low complication rate. Increasing stone volume and density reduces the success of ESWL.

Efficacy Of Alpha-Adrenergic Receptor Antagonists In The Treatment Of Distal Ureteric Stones: A Paediatric Study.

European association of urology (EAU) recommended α- blockers for managing distal ureteric stones in the paediatric population. This paper will help to understand the efficacy of Silodosin as a medical expulsive agent for distal ureteric stones in children, along with the required time duration of stone expulsion. Forty participants were enrolled and evaluated for complaints, pain severity, associated symptoms, and ultrasound was done to confirm the position and size of the distal stone. Follow-ups were scheduled after every 7 days (1 week) for redo ultrasound and assessment of the stone position. Data was entered and analyzed in the SPSS version 23. To evaluate the significance of data chi-square test was performed, p-value <0.005 was considered significant. The minimum and maximum age limits recorded are 3 years and 18 years respectively with a mean age of 9.5±4.5 years and mean stone size was measured as 0.6±0.1 cm. Distribution of stone size indicated the minimum size of 0.4 cm and maximum of 1.0 cm stone in study subjects. Maximum stone expulsion was reported within 14 days or an initial 2 follow-up scans. The efficacy of Silodosin and medical expulsive therapy evaluated the effect on pain management as pain episodes declined with Silodosin treatment and spontaneous passage of stones were increased within the first 14 days of treatment. This study will be a beneficial contribution in literature especially in a developing country population where paediatric urolithiasis is on expansion and ongoing.

Medical Expulsive Therapy (MET) for Ureteral Calculi in Children: Systematic Review and Meta-Analysis

BackgroundMedical expulsive therapy (MET) is the use of medication to facilitate ureteral stone passage prior to surgical intervention. Practice guidelines for the use of MET in the pediatric population remain limited, primarily due to a scarcity of randomized controlled trials and concerns regarding dosing and side effects. To address this, we conducted a systematic review and meta-analysis to clarify the impact of MET on the spontaneous passage of pediatric stones located within the distal ureter.MethodsA narrow scope search using PubMed and Embase with a predefined search strategy was performed in September 2021 to identify all randomized controlled trials involving the use of pediatric MET for stones located in the distal ureter. Raw data from 6 eligible articles were extracted for pooled analysis. Our primary outcome was the overall effect of MET on ureteral calculi passage within 28 days compared to controls.ResultsThe mean age of patients in included studies was 7.6 years-old, with a range of ages 2–18 years old. In the pooled analysis of eligible studies, 235 patients received MET and 176 received placebo. The mean stone size was 6.40 mm in the treatment arm and 6.42 mm in the control arm. Children receiving MET were more likely than controls to experience spontaneous stone passage [Relative risk 1.39 (CI 95% 1.21–1.60)]. Considering all included studies, only one child treated with MET withdrew due to medication side effects.ConclusionOur systematic review and meta-analysis of the use of pediatric MET on spontaneous distal ureteral stone passage demonstrates a statistically significant benefit. The benefits of MET are diverse and include, possibly, minimizing exposure to anesthesia and radiation alongside improving surgical outcomes if ureteroscopy must be performed. Given the increasing incidence of ureteral stones in children and the nuances inherent to pediatric surgery due to smaller anatomy, MET represents an opportunity for safer and more effective pediatric stone management.

Micro-ureteroscopy (m-URS) for treatment of upper ureteral stones in children: A new, different approach.

Micro-ureteroscopy (m-URS) for treatment of upper ureteral stones in children: A new, different approach.

Effectiveness of ultrasound-guided shockwave lithotripsy and predictors of its success rate in pediatric population: A report from a national reference center

Shockwave lithotripsy (SWL) remains a well-established treatment modality for many of the pediatric renal and ureteral stones. Repeated SWL sessions carry limitations due to the use of general anesthesia and X-ray radiation. The objective of our study was to evaluate stone-free rate (SFR) of 1-session of SWL for the management of pediatric renal and ureteral stones less than 2cm performed exclusively under ultrasound guidance and identify factors influencing its success. The study utilized a retrospective cohort design including 124 consecutive pediatric patients with 133 renal and ureteral stones less than 2cm whom SWL was performed in the period of January 2008 to December 2019. SWL procedures were performed by one expert surgeon in a single, national reference center, exclusively under ultrasound guidance using Modulith® SLK lithotripter. Follow-up was performed in post-SWL 2nd, 4th, 12th weeks and 6 months. The mean age of the children was 10 years (SD=6.0) and the mean stone size was 10.4mm (SD=3.6mm). Sedation type of anesthesia was used in 80 patients (64.5%). No major complication was developed, and no ureteral stenting was required in any of the patient following SWL. The SFR following 1-session of SWL was 88.0% at 12-week. Younger age (P=0.002), sedation type of anesthesia (P=0.001) and presence of radiolucent stones (P=0.033) significantly improved post-SWL early stone clearance on univariate analysis, the latter being the only significant factor according to final model (P=0.031). Ultrasound-guided SWL represents a safe and effective method for the management of both renal and ureteral stones in children. The SFR following 1-session of SWL at 12-weeks was achieved in 88.0%, the overall success rate after all SWL sessions reaching 91.7%. A higher success rate was observed in children harboring radiolucent stones.

Urologic treatment of nephrolithiasis.

The purpose of this review is to describe the options and recent developments in the urologic treatment of nephrolithiasis in children. The prevalence of nephrolithiasis in children has increased over time. The urologic treatment of nephrolithiasis ranges from observation to medical expulsive therapy with an alpha blocker for a stone in a ureter to a variety of procedures for stone removal. Observation for small, asymptomatic renal stones is a reasonable strategy in children. Medical expulsive therapy with an alpha blocker may have a beneficial effect for passage of ureteral stones in children. Extracorporeal shock wave lithotripsy (ESWL) remains an important treatment for nephrolithiasis in children. Advances in ureteroscopy with clearer digital imaging and single use ureteroscopes have made ureteroscopy more attractive. Percutaneous nephrolithotomy is a more invasive treatment modality but remains a good choice for children with large-stone burdens and instruments are getting smaller. Open or laparoscopic stone surgery should be reserved for unique cases. Nephrolithiasis is increasing in children with differing urologic management options depending on the clinical scenario. A shared decision-making process with discussion of risks and benefits should be used to help patients and families choose a treatment option.

Ho:YAG laser versus pneumatic lithotripsy for management of pediatric ureteral stones: a prospective–comparative analysis with adults

There are limited number of studies comparing the results of Holmium:YAG laser lithotripsy (LL) and pneumatic lithotripsy (PL) for pediatric ureteral stones. To perform a comparative analysis of LL and PL in the management of ureteral stones in children and adults. Ninety-eight children (56 boys and 42 girls) and 623 adults (360 men and 263 women), who were treated for ureteral stones at our clinic between 2017 and 2019, were the subjects of this study. Patients were grouped according to their age as group 1 (n:98, pediatric [<18 age]) and group 2 (n:623, adult [≥18 age]). The patients were then grouped according to lithotripter type as laser (n:580) and pneumatic (n:141). The effects of lithotripter type, stone size and location, and operative times on success and complication rates were investigated. In both groups, mean operation time was in favor of PL (14.6 vs 22.8min, p=0.042 and 26.4 vs 36.3min, p=0.013, respectively). In both groups, overall stone-free rates (SFR) were in favor of LL (86.8% vs 66.7%, p<0.001, and 83% vs 73.9%, p=0.005, respectively), but there was no significant difference in overall SFRs between adults and children (78.4% vs 76.7, p=0.390). Retreatment rates were higher in the pneumatic group in both children and adults (p=0.026 and p=0.041, respectively). While there was no significant difference in the overall complication rates between adults and children (53.5% vs 40.6%, p=0.816), the rate of complications with LL was lower in adults (37.7% vs 69.4%, p<0.001) (TABLE). This paper is the first to report a comparative analysis of factors affecting URS success in adults and children. SFRs were higher in all ureteral locations for LL. LL, lower ureteral location, and <6mm ureteral stone were determined as the predictors of success for both pediatric and adult patients. The presence of multiple surgeons with different levels of experience is the main limitation of this study. Both LL and PL are safe in children and adults with similar clinically insignificant complication rates. However, in the short term, LL provides better SFRs in both children and adults, especially in the upper ureteral stones. Surgeons should decide the energy technique to be used in URS according to the characteristics of the stone rather than the patient's age group.

What predicts spontaneous passage of ≤ 1 cm ureteral stones in children?

PurposeThe aim of this study is to determine what factors predict spontaneous passage of ≤1 cm ureteral stones in children. MethodsFiles of the patients diagnosed with a single ureteral stone on a given side between 2008 and 2017 were retrospectively reviewed. Patients with congenital obstructive uropathy, neurogenic bladder, vesicoureteral reflux and those with a stone diameter of >1 cm were excluded. Detection of ureteral stones was done using ultrasonography (US) primarily, and computed tomography when US findings were inconclusive. Patients were treated either conservatively or surgically. Conservative treatment included adequate hydration and pain management whereas surgical treatment included ureteroscopic intervention. Apart from those who required urgent intervention, patients were referred for surgical treatment after 2–4 weeks of follow-up with no spontaneous passage. Factors analyzed for association of spontaneous passage included age, gender, type of hematuria, stone localization, laterality, presence of concomitant kidney stone, degree of hydronephrosis, stone size and stone composition. ResultsA total of 70 patients (38 males, 32 females); median age 4.7 years had a ≤ 1 cm ureteral stone (median diameter 7 mm). US was able to diagnose the ureteric stone in 47 patients while computed tomography was required in 23 patients. Spontaneous passage was observed in 40 patients (57.1%). Median time for stone passage was 8 days (3–34 days). Stone size and presence of hematuria (macroscopic and microscopic combined) were factors associated with spontaneous passage and 6.7 mm was found to be the cut-off (AUC = 0.953; 95% CI 0.905–1.000; sensitivity 96.7%, specificity 82.5%, p < 0.001). Moreover, age, degree of hydronephrosis or stone location were not associated with spontaneous passage. ConclusionPatients with a ureteric stone size <6.7 mm can safely be followed conservatively, with a spontaneous passage rate of 82.5%.Type of StudyCase series with no comparison group.Level of EvidenceIV

Ureteroscopic lithotripsy for ureteral stones in children using holmium: yag laser energy: results of a multicentric survey

Holmium:YAG (Ho:YAG) laser lithotripsy has broadened the indications for ureteroscopic stone managements in adults, but few evidence are currently available in the pediatric population. This article aimed to assess the outcome of Ho:YAG laser lithotripsy during retrograde ureteroscopic management of ureteral stones in different locations in children. The medical records of 149 patients (71 boys and 78 girls; median age 9.2 years) treated with Ho:YAG laser ureteroscopic lithotripsy in five international pediatric urology units over the last 5 years were retrospectively reviewed. Exclusion criteria included patients with renal calculi and/or with a history of ipsilateral stricture, renal failure, active urinary tract infection, or coagulation disorder. Stones were treated with dusting technique in all cases. The median stone size was 10.3mm (range 5-17). Stones were located in the distal ureter in 77 cases (51.7%), in the middle ureter in 23 cases (15.4%), and in the proximal ureter in 49 cases (32.9%). The median operative time was 29.8min (range 20-95). Intra-operative complications included five bleedings (3.3%) and seven stone retropulsions (4.7%). Overall stone-free rate was 97.3%. Overall postoperative complications rate was 4.0% and included two cases of stent migration (1.3%) (Clavien II) and four residual stone fragments (2.7%) that were successfully treated using the same technique (Clavien IIIb). On multivariate analysis, re-operation rate was significantly dependent on the proximal stone location and presence of residual fragments >2mm (P=0.001). This study is one of the largest pediatric series among those published until now. The study series reported a shorter operative time, a higher success rate, and a lower postoperative complications rate compared with previous series. A limitation of this study is that stone-free rates may be somewhat inaccurate using ultrasonography and plain X-ray compared with computed tomography (CT); the study's 97.3% success rate may be overestimated because no CT scan was done postoperatively to check the stone-free rate. Other limitations of this article include its retrospective nature, the multi-institutional participation, and the heterogeneous patient collective. The Ho:YAG laser ureteroscopic lithotripsy seems to be an excellent first-line treatment for children with ureteral stones, independently from primary location and size. However, patients with proximal ureteral stones and residual fragments >2mm reported a higher risk to require a secondary procedure to become stone-free. Combination of techniques as well as appropriate endourologic tools are key points for the success of the procedure regardless of stones' size and location.

Ureteroscopy cost effective for distal ureteral stones in children

Ureteroscopy cost effective for distal ureteral stones in children

Cost-Effectiveness Analysis of the Management of Distal Ureteral Stones in Children

To determine the most cost-effective approach to the management of distal ureteral stones in children given the potential for recurrent renal colic during a trial of passage versus potential stent discomfort and complications of ureteroscopy. We developed a decision tree to project costs and clinical outcomes associated with observation, medical explusive therapy (MET), and ureteroscopy for the management of an index patient with a 4-mm-distal ureteral stone. We determined which strategy would be least costly and offer the most pain-free days within 30days of diagnosis. We performed a one-way sensitivity analysis on the probability of successful stone passage with MET. We obtained probabilities from the literature and costs from the 2016 Pediatric Health Information System Database. Ureteroscopy was the costliest strategy but maximized the number of pain-free days within 30days of diagnosis ($5282/29 pain-free days). MET was less costly than ureteroscopy but also less effective ($615/21.8 pain-free days). Observation cost more than MET and was also less effective ($2139/15.5 pain-free days). The one-way sensitivity analysis on the probability of successful stone passage with MET demonstrated that ureteroscopy always has the highest net monetary benefits value and is therefore the recommended strategy given a fixed willingness-to-pay. Using a rigorous decision-science approach, we found that ureteroscopy is the recommended strategy in children with small distal ureteral stones. Although it costs more than MET, it resulted in more pain-free days in the first 30days following diagnosis given the faster resolution of the stone episode.

Silodosin in the treatment of distal ureteric stones in children: A prospective, randomised, placebo-controlled study

ObjectivesTo evaluate the possible role of silodosin (a highly selective α1A-adrenoceptor antagonist) in facilitating the passage of distal ureteric stones (DUS) in children, as the role of α-blockers as medical expulsive therapy is well known in adults. Patients and methodsIn all, 40 paediatric patients (27 boys and 13 girls) diagnosed with unilateral, single, radiopaque DUS of <10mm were included in the study. Their mean (SD, range) age was 8.1 (2.7, 5–17)years. The patients were randomly divided into two groups: Group A, received silodosin 4mg as a single bedtime dose; and Group B, received placebo as a single bedtime dose. Ibuprofen was prescribed to both groups on-demand for pain episode relief. Patients were followed up biweekly for 4weeks. The stone expulsion time and rate, pain episodes, analgesic use, and any adverse effects were recorded. ResultsThe mean (SD) stone size in Group A was 6.6 (1.7)mm and in Group B was 6.7 (1.4)mm (P=0.4). Two patients were lost to follow-up (one from each group), and one patient in Group A refused to complete the study. The stone-free rate at end of the 4-week treatment period was 88.8% in Group A vs 73.6% in Group B (P=0.4). The mean (SD) stone expulsion time was 7.0 (4.3) vs 10.4 (4.7)days in groups A and B, respectively (P=0.02). The mean (SD) number of pain episodes requiring ibuprofen was 2.3 (1.4) vs 4.7 (2.6) episodes in groups A and B, respectively (P<0.001). Adverse effects (headache and dizziness) were recorded in three patients (16.7%) in Group A, which were mild and none of them discontinued treatment, whilst no adverse effects were recorded in Group B. ConclusionsThe data in the present study show that silodosin can be safely used in the treatment of DUS in children for decreasing time to stone expulsion, pain episodes, and analgesic requirement.

MP90-18 SILODOSIN FOR MEDICAL EXPULSIVE THERAPY IN CHILDREN WITH DISTAL URETERAL STONE: A PROSPECTIVE RANDOMIZED, PLACEBO-CONTROLLED, SINGLE BLIND STUDY STUDY

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy1 Apr 2017MP90-18 SILODOSIN FOR MEDICAL EXPULSIVE THERAPY IN CHILDREN WITH DISTAL URETERAL STONE: A PROSPECTIVE RANDOMIZED, PLACEBO-CONTROLLED, SINGLE BLIND STUDY STUDY Ahmed fahmy, hazem Rhasad, Amr Kamal, and Moustafa Elsawy Ahmed fahmyAhmed fahmy More articles by this author , hazem Rhasadhazem Rhasad More articles by this author , Amr KamalAmr Kamal More articles by this author , and Moustafa ElsawyMoustafa Elsawy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2837AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Silodosin, a selective a1-blocker,has been proposed for medical expulsive therapy (MET) instead of tamsulosin in adulthood urolithiasis with promising outcomes but studies comparing these substances for MET in children are lacking. The aim of this study was to verify the safety and efficacy of silodosin (8 mg) compared with tamsulosin (0.4 mg) and placebo as a MET for distal ureteral stones in children. METHODS A prospective randomized placebo-controlled study including 90 children diagnosed with unilateral, single, radio-opaque distal ureteral stones < 10 mm in size was conducted. Age ranged between 5.8 and 18 years old. Patients were randomized into three groups; silodosin group (n = 30) received 8 mg silodosin daily, tamsulosin group (n = 30) received 0.4 mg tamsulosin daily and placebo group (n = 30) were not given any of the above medications. Patients were offered a closely monitored trial for spontaneous stone passage in the 4-week period prior to definitive therapy. The stone clearance rate, time to stone clearance, number of pain episodes, need for analgesia and potential side effects of medications were observed. RESULTS The stone clearance rates for silodosin, tamsulosin and placebo groups were 78.5, 66.6 and 53.3 %, respectively. The time to stone clearance was significantly shorter in silodosin and tamsulosin groups than in placebo group (p = 0.006 and 0.035, respectively). Patients taking silodosin and tamsulosin had fewer pain attacks and lesser analgesic requirement than placebo group patients. CONCLUSIONS The current study showed the use of a-blockers for MET of lower ureteric stones in children to be effective, however, the use of silodosin was associated with higher stone clearance rates and shorter time to stone clearance as compared to tamsulosin. Both of these medications demonstrated a good safety and tolerability profile for MET in children with uncomplicated ureteral stones. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1217 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Ahmed fahmy More articles by this author hazem Rhasad More articles by this author Amr Kamal More articles by this author Moustafa Elsawy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...