COMPRARISON OF TREATMENT METHODS FOR UROLITHIASIS IN CHILDREN WITH THE APPLICATION OF ESWL AND URSL METHODS

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Adam Haliński, Andrzej Haliński Provincial Hospital, Zielona Góra, Poland, Department of Paediatric Surgery and Paediatric Urology Specialized

1 Adam Haliński, Andrzej Haliński Provincial Hospital, Zielona Góra, Poland, Department of Paediatric Surgery and Paediatric Urology Specialized Medical Centre UROLOG, Zielona Góra, Poland COMPRARISON OF TREATMENT METHODS FOR UROLITHIASIS IN CHILDREN WITH THE APPLICATION OF ESWL AND URSL METHODS

2 Kurdejov AGENDA 1) Objectives of the presentation 2) Material and method 3) Results 4) Conclusions

3 Objective of the Presentation - comparison of the effectiveness of ESWL and URSL methods in the treatment for urolithiasis in children; - establishing the indications for the treatment with the application of one of the methods according to: - the location of the stone - stone size - urinary obstruction - a child age Kurdejov

4 Kurdejov Material and Method The evaluation assessed 91 children (aged 2 16) treated for urolithiasis in the years children (aged 2-16; mean 8,7) were treated with the application of ESWL; 46 children (aged ;mean 8,2) were treated with the application of URSL;

source device PIEZOLITH WOLF 3000 with a double system of stone location

5 Material and Method URSL semi-rigid ureterorenoscope 6 F, 2 operating channels, lithoclast, Holmium Laser Litho 2100 ESWL a piezoelectric energy source device PIEZOLITH WOLF 3000 with a double system of stone location (ultrasonography and X-ray), general anaesthesia, in selected cases contrast during surgery;

6 Kurdejov Material and Method The treatment was applied to children with stones in the ureter not promising spontaneous expulsion with urine. The children were divided into 3 groups: I group - stone size 5-7mm II group - stone size 8-10mm III group - stone size exceeding 10mm

7 Kurdejov Results Very Good complete removal of the stone, no complications; Good residual stone to 4mm, temporary hematuria, minor aches and pains; Bad stone in the ureter, complications /colic, hematuria, obstruction in the urinary tract/

8 Results ESWL - 45 children Very Good - 57%, 26 children, I group - stones of 5-7mm occupying the ureter for a short time / no urinary obstruction Good - 28,9%, 13 children, II group stones of 8-10mm, widening of the urinary tract Bad - 13,3%, 6 children, III group - stones exceeding 10mm occupying the ureter for a long time, obstruction in the urinary tract, colic Kurdejov

9 Results URSL - 46 children Very Good - 73%, 34 children, I, II, III group, obstruction or no obstruction in the urinary tract; Good Bad %, 8 children, I, II, III group, no obstruction, obstruction in the urinary tract; - 8.7%, 4 children, II, III group, transplant ureteral stenosis, skeletal system defect, displacement of stone to kidney Kurdejov

10 Kurdejov Results Complications after URSL - moderately haematuria for 2 days in 17 children /36%/ - colic in 10 children 21% - renal collective system perforation with urethral catheter pin in 1 child - 1,23%

11 CONCLUSIONS Kurdejov

12 13,3% 8.7% 28,9% 57.8% 17.4% 73.9% 1. URSL method is more effective than ESWL method for a ureteral stone of any size in children, but it carries a greater risk of complications. Kurdejov

13 Kurdejov ESWL is a good choice for smaller stones (to 7mm), situated mainly in the upper part of a ureter, occupying the ureter for a short time, permeating urine. 3. In case of URSL, the size of a stone in the ureter is less important, as well as urinary obstruction and residence time in the urinary tract. The location of a stone in the upper part of the ureter, anatomical defects of a skeletal system and ureteral stricture may be a significant difficulty in using this method in children. 4. Age of a child does not influence the choice of a treatment method. 5. ESWL and URSL are the treatments of choice for the treatment of urolithiasis in children due to low invasiveness and high efficiency. 6. Numerous parents choose ESWL as the first treatment of their child, considering it to be safer.

14 Grünberg Green Hill

ISSN East Cent. Afr. J. surg. (Online)

ISSN East Cent. Afr. J. surg. (Online) 87 Ureteroscopy in a Resource Limited Setting: The Tikur Anbessa General Specialized Hospital Experience in Addis Ababa, Ethiopia. D. Andualem, L. Be-ede, T. Mulat, L. Samodi Addis Ababa University-School