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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pediatr. | doi: 10.3389/fped.2019.00324

Difficulties in Diagnosis and Treatment of Ureterolithiasis in Preschool Children and the Interest of URS-L for Treating this Age Group.

 Adam Halinski1, 2*, Andrzej Halinski1, 3, Marcin Zaniew4,  Bartosz Kudliński5, Jolanta Soltysiak6,  Bartłomiej Sobolewski5 and  Henri Steyaert7
  • 1Clinical Department of Paediatric Surgery and Urology, University of Zielona Góra, Poland
  • 2Department of Paediatric Urology, Klinika "Wisniowa", Poland
  • 3Department of Paediatric Urology, Klinika 'Wisniowa', Poland
  • 4Clinical Department of Paediatrics, University of Zielona Góra, Poland
  • 5Department of Paediatric Urology, Cherry Clinic, Poland
  • 6Poznan University of Medical Sciences, Poland
  • 7Department of Pediatric Surgery, Queen Fabiola Children's University Hospital, Belgium

Urolithiasis can affect all children aged 0 to 6 years. Diagnostic difficulties in the youngest children are due to the problems in locating pain and determining its character and severity. In keeping with the ALARA (As Low As Reasonably Achievable) protocol, the number of imaging tests possible to perform is very limited. Ultrasound is the first line exam of choice. After diagnosis of the presence of a stone, ESWL (Extracorporeal Shock Wave Lithotrypsy) should always be considered and offered to parents due to its high effectiveness and minimal invasiveness - especially for this age group. If ESWL is contraindicated or not well accepted by parents, the next therapeutic option is an endoscopic approach: URS-L (Uretherorenoscopy – Lithotrypsy). Our study clinically analyzes 87 children, which were treated between 2009-2017 using the URS-L procedure. URS-L treatments were performed using Lithoclast until 2009, and after that time, using the holmium laser Ho:YAG. The overall effectiveness of treatments was 93.3%. There was no failure in the access to the stones. A macroscopic hematuria (Clavien-Dindo I grade) was observed through the second post-operative day in 9.2% of treated patients. No urosepsis was observed. Full metabolic evaluation was performed on all patients. Children remained under constant urological and nephrological observation. A recurrence of urolithiasis was observed in 35.6% of the cases. Treating ureteral lithiasis in young infants remains a big challenge. Our series shows that modern minimal invasive techniques used by very experienced pediatric urologists in high volume centers gives excellent results. In most cases, surgery should no longer need to be an option.

Keywords: stone disease, laser, ureterorenoscopy, Preschool children, DJ catheter

Received: 27 Mar 2019; Accepted: 18 Jul 2019.

Copyright: © 2019 Halinski, Halinski, Zaniew, Kudliński, Soltysiak, Sobolewski and Steyaert. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Adam Halinski, University of Zielona Góra, Clinical Department of Paediatric Surgery and Urology, Zielona Góra, 65-417, Lubusz, Poland, adamhalinski@gmail.com