title: Holmium laser ureteroscopic treatment of various pathologic features in pediatrics.
abstract: OBJECTIVE
  To assess the outcome of pediatric patients treated by ureteroscopy for various pathologic findings.
  
  
  METHODS
  A total of 31 children (median age 5 years, range 0.3 to 14) were ureteroscopically treated for ureteropelvic junction obstruction (UPJO) (n = 6, 1 primary and 5 secondary), ureteral strictures (n = 4), and calculi (n = 21). Miniscopes with a holmium laser were used for lithotripsy and ureterotomy.
  
  
  RESULTS
  The average age in the UPJO group was 1.8 years (range 0.3 to 4), the operative time was 40 minutes (range 30 to 50), and the hospitalization was 1.2 days (range 1 to 2). A successful clinical and functional outcome was maintained after an average follow-up of 16 months (range 8 to 30). The 4 cases of ureteral stricture included two located in the middle ureter and two at the ureterovesical junction. No failures had occurred in this group after an average follow-up of 25 months (range 8 to 40). The calculi cases comprised 10 lower ureteral, 2 upper ureteral, and 9 renal stones, with an average stone burden of 11 mm (range 5 to 20). Three patients (14%) underwent preoperative stenting. Two patients (10%) required ureteral orifice dilation. Postoperatively, 4 patients (18%) had a ureteral catheter left in place, 15 (71%) had an internal stent with an externalized string, and 2 (10%) did not require drainage. The average operative time was 39 minutes (range 15 to 90), and the hospitalization was 1 day (range 0.5 to 2). All patients were rendered stone free.
  
  
  CONCLUSIONS
  The results of our study have shown that the ureteroscopic approach in children with UPJO, ureteral strictures, and urinary calculi is safe and highly effective. Routine preoperative stenting and intraoperative ureteral dilation are not necessary. Stents with external strings were well tolerated and easily removed without anesthesia.
authors: Service of Endourology, Tel-Aviv Sourasky Medical Center, Tel-Aviv University Sackler Faculty of Medicine, Tel-Aviv, Israel. mariosofer@hotmail.com
authors: Mario
authors: M
authors: Sofer
authors: Joseph
authors: J
authors: Binyamini
authors: Perla M
authors: PM
authors: Ekstein
authors: Yuval
authors: Y
authors: Bar-Yosef
authors: Juza
authors: J
authors: Chen
authors: Haim
authors: H
authors: Matzkin
authors: Jacob
authors: J
authors: Ben-Chaim
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D004106:Dilatation; D005260:Female; D006695:Holmium; D006801:Humans; D007223:Infant; D053685:Laser Therapy; D017602:Lithotripsy, Laser; D008297:Male; D015607:Stents; D014513:Ureter / Q000473:pathology; D014517:Ureteral Obstruction / Q000601:surgery*; D018666:Ureteroscopy; D014545:Urinary Calculi / Q000737:chemistry / Q000628:therapy
chemical_list: D006695:Holmium