Abstract
Distal ureteral stones are commonly treated by extracorporeal shock wave lithotripsy (ESWL) as first option in adult age patients, but no agreement is achieved about the treatment in children. Efficacy and safety of ureteroscopy with ureterolithotripsy (ULT) was compared with ESWL results for distal ureteral calculi treatment in childhood.
Materials e Methods
From July 2002 to July 2003, paediatric patients presenting ureteral stones were consecutively randomized for treatment, using ULT or ESWL. The success rate, effectiveness quotient, complication rate and hospitalization length were evaluated. T-Student test (chi-square) was adopted for statistical analysis.
Results
A total of 31 patients, aged 2 to 17 years (mean age 7.2 years) were recruited. ULT was performed in 17 children. All the females (100%) and 4 males (80%) were stone-free in a single endoscopic procedure. ESWL was performed as a primary procedure in 14 cases, 5 males and 9 females. Four females (44.4%) and 2 males (40%) resulted stone-free at first treatment. The total stone-free rate was 94.1% for ULT and 42.8% for ESWL (p=0.004). Eight patients (57%) underwent a second ESWL and 3 of them (37.5%) became stone-free súbsequently. The 5 patients (62.5%) with failed double ESWL underwent ULT successfully. The calculated efficiency quotient for treating distal ureteral calculi was significantly lower in the ESWL than in the ULT group (p=0.05).
Conclusions
ULT should be recommended as treatment of choice for distal ureteral calculi in childhood. Using small ureteroscopes the target stone was treated safety and effectively in our patients.
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