Skip to main content
SpringerLink
Log in

Holmium:YAG laser ureteroscopic lithotripsy for ureteric calculi in children: predictive factors for complications and success

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the impact of age, stone size, location, radiolucency, extraction of stone fragments, size of ureteroscope and presence and degree of hydronephrosis on the efficacy and safety of holmium:YAG (Ho:YAG) laser lithotripsy in the ureteroscopic treatment of ureteral stones in children.

Methods

Between October 2011 and May 2013, a total of 104 patients were managed using semirigid Ho:YAG ureterolithotripsy. Patient age, stone size and site, radiolucency, use of extraction devices, degree of hydronephrosis and size of ureteroscope were compared for operative time, success and complications.

Results

In all, 128 URS were done with a mean age of 4.7 years. The mean stones size was 11 mm. Success rate was 81.25 %. Causes of failure were 12.5 % access failure, 1.5 % extravasation and 4.7 % stone migration. Overall complications were 23.4 %. Failure of dilatation and extravasation were detected only in children <2 years old. Extravasation was significantly higher in smaller ureters and cases with stone size >15 mm. Stone migration was significantly higher in upper ureteric stones.

Conclusions

Failure and complications rates in Ho:YAG ureterolithotripsy were significantly affected by younger age (<2 years), upper ureteric stones and smaller ureters but were not related to stone radiolucency or degree of hydronephrosis. Larger stones (>15 mm) were associated with increased complications. After multivariate analysis, the age of the patients remained significant predictor for failure of dilatation and stone migration, while size of the ureter was the only significant predicting factor for failure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Raza A, Smith G, Moussa S, Tolley D (2005) Ureteroscopy in the management of pediatric urinary tract calculi. J Endourol 19(2):151–158

    Article  PubMed  Google Scholar 

  2. Van Savage JG, Palanca LG, Andersen RD, Rao GS, Slaughenhoupt BL (2000) Treatment of distal ureteral stones in children: similarities to the American urological association guidelines in adults. J Urol 164(3 Pt 2):1089–1093

    Article  PubMed  Google Scholar 

  3. Johnson DE, Cromeens DM, Price RE (1992) Use of the Ho:YAG laser in urology. Lasers Surg Med 12(4):353–363

    Article  CAS  PubMed  Google Scholar 

  4. Matsouka K, Iida S, Inoue M, Yoshii S, Arai K, Tomiyasu K et al (1999) Endoscopic lithotripsy with the holmium:YAG Laser. Lasers Surg Med 25(5):389–395

    Article  Google Scholar 

  5. VanDervoort K, Wiesen J, Frank R, Vento S, Crosby V, Chandra M et al (2007) Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome. J Urol 177:2300–2305

    Article  PubMed  Google Scholar 

  6. Thomas JC, DeMarco RT, Donohoe JM, Adams MC, Brock JW 3rd, Pope JC 4th (2005) Pediatric ureteroscopic stone management. J Urol 174:1072–1074

    Article  PubMed  Google Scholar 

  7. De Dominicis M, Matarazzo E, Capozza N, Collura G, Caione P (2005) Retrograde ureteroscopy for distal ureteric stone removal in children. BJU Int 95:1049–1052

    Article  PubMed  Google Scholar 

  8. Turk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, et al. (2013) Guidelines on urolithiasis. Eur Assoc Urol, http://www.uroweb.org/publications/eau-guidelines/

  9. Teichman JM, Vassar GJ, Bishoff JT, Bellman GC (1998) Holmium:YAG lithotripsy yields smaller fragments than lithoclast, pulsed dye laser or electrohydraulic lithotripsy. J Urol 159:17–23

    Article  CAS  PubMed  Google Scholar 

  10. Leijte JA, Oddens JR, Lock TM (2008) Holmium laser lithotripsy for ureteral calculi: predictive factors for complications and success. J Endourol 22(2):257–260. doi:10.1089/end.2007.0299

    Article  PubMed  Google Scholar 

  11. Imamura Y, Kawamura K, Sazuka T, Sakamoto S, Imamoto T, Nihei N et al (2013) Development of a nomogram for predicting the stone-free rate after transurethral ureterolithotripsy using semi-rigid ureteroscope. Int J Urol 20:616–621

    Article  PubMed  Google Scholar 

  12. Seitz C, Tanovic E, Kikic Z, Fajkovic H (2007) Impact of stone size, location, composition, impaction, and hydronephrosis on the efficacy of holmium:YAG-Laser Ureterolithotripsy. Eur Urol 52(6):1751–1757

    Article  PubMed  Google Scholar 

  13. Gupta PK (2007) Is the holmium:YAG laser the best intracorporeal lithotripter for the ureter? A 3-year retrospective study. J Endourol 21(3):305–309

    Article  PubMed  Google Scholar 

  14. Erturhan S, Yağci F, Sarica K (2007) Ureteroscopic management of ureteral calculi in children. J Endourol 21(4):397–400

    CAS  PubMed  Google Scholar 

  15. El-Assmy A, Hafez AT, Eraky I, El-Nahas AR, El-Kappany HA (2006) Safety and outcome of rigid ureteroscopy for management of ureteral calculi in children. J Endourol 20(4):252–255

    Article  PubMed  Google Scholar 

  16. Ozkan KU, Bakan V, Mil A, Ozturk S (2010) Ureteroscopic stone management in prepubertal children. Urol Int 85:320–323

    Article  PubMed  Google Scholar 

  17. Yucel S, Akin Y, Kol A, Danisman A, Guntekin E (2011) Experience on semirigid ureteroscopy and pneumatic lithotripsy in children at a single center. World J Urol 29(6):719–723. doi:10.1007/s00345-010-0599-2 Epub 2010 Oct 7

    Article  PubMed  Google Scholar 

  18. Turunc T, Kuzgunbay B, Gul U, Kayis AA, Bilgilisoy UT, Aygun C, Ozkardes H (2010) Factors affecting the success of ureteroscopy in management of ureteral stone diseases in children. J Endourol 24(8):1273–1277. doi:10.1089/end.2009.0476

    Article  PubMed  Google Scholar 

  19. Dogan HS, Onal B, Satar N, Aygun C, Piskin M, Tanriverdi O et al (2011) Factors affecting complication rates of ureteroscopic lithotripsy in children: results of multi-institutional retrospective analysis by pediatric stone disease study group of Turkish pediatric urology society. J Urol 186(3):1035–1040. doi:10.1016/j.juro.2011.04.097 Epub 2011 Jul 23

    Article  PubMed  Google Scholar 

  20. Basiri A, Zare S, Shakhssalim N, Hosseini Moghaddam SM (2008) Ureteral calculi in children: what is best as a minimally invasive modality? Urol J 5(2):67–73

    PubMed  Google Scholar 

  21. Galal EM, Fath El-Bab TK, Abdelhamid AM (2013) Outcome of ureteroscopy for treatment of pediatric ureteral stones. J Pediatr Urol 9(1):e58–e63

    Article  Google Scholar 

  22. Geavlete P, Georgescu D, Niţă G, Mirciulescu V, Cauni V (2006) Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-center experience. J Endourol 20(3):179–185

    Article  PubMed  Google Scholar 

  23. Tiryaki T, Azili MN, Ozmert S (2013) Ureteroscopy for treatment of ureteral stones in children: factors influencing the outcome. Urology 81(5):1047–1051. doi:10.1016/j.urology.2013.01.008 Epub 2013 Mar 7

    Article  PubMed  Google Scholar 

  24. Garg S, Mandal AK, Singh SK, Naveen A, Ravimohan M, Aggarwal M et al (2009) Ureteroscopic laser lithotripsy versus ballistic lithotripsy for treatment of ureteric stones: a prospective comparative study. Urol Int 82(3):341–345. doi:10.1159/000209369 Epub 2009 May 11

    Article  CAS  PubMed  Google Scholar 

  25. Schuster TG, Hollenbeck BK, Faerber GJ, Wolf JS Jr (2001) Complications of ureteroscopy: analysis of predictive factors. J Urol 166:538–540

    Article  CAS  PubMed  Google Scholar 

  26. Gunlusoy B, Degirmenci T, Kozacioglu Z, Arslan M, Ceylan Y, Nergiz N, Minareci S (2013) Factors affecting the complications of pneumatic lithotripsy for the treatment of ureteral stones with different localizations: a multivariate analysis of complications. Urol Int. doi:10.1159/000350243 [Epub ahead of print]

  27. Bogris S, Papatsoris AG (2010) Status quo of percutaneous nephrolithotomy in children. Urol Res 38(1):1–5

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Division of Pediatric Urology, Aboul-Riche Children’s Hospital, Cairo University, Cairo, Egypt

    Mohammed S. Elsheemy, Ahmed Maher, Ahmed M. Shouman, Ahmed I. Shoukry & Hany A. Morsi

  2. Urology Department, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt

    Khaled Mursi & Alaa Meshref

Authors
  1. Mohammed S. Elsheemy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmed Maher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Khaled Mursi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ahmed M. Shouman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ahmed I. Shoukry
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hany A. Morsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alaa Meshref
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohammed S. Elsheemy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Elsheemy, M.S., Maher, A., Mursi, K. et al. Holmium:YAG laser ureteroscopic lithotripsy for ureteric calculi in children: predictive factors for complications and success. World J Urol 32, 985–990 (2014). https://doi.org/10.1007/s00345-013-1152-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-013-1152-x

Keywords

Search

Navigation