title: Holmium:YAG laser ureteroscopic lithotripsy for ureteric calculi in children: predictive factors for complications and success.
abstract: OBJECTIVE
  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.
authors: Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt, mohammedshemy@yahoo.com.
authors: Mohammed S
authors: MS
authors: Elsheemy
authors: Ahmed
authors: A
authors: Maher
authors: Khaled
authors: K
authors: Mursi
authors: Ahmed M
authors: AM
authors: Shouman
authors: Ahmed I
authors: AI
authors: Shoukry
authors: Hany A
authors: HA
authors: Morsi
authors: Alaa
authors: A
authors: Meshref
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design / Q000009:adverse effects; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000150:complications; D015994:Incidence; D007223:Infant; D053844:Lasers, Solid-State / Q000009:adverse effects* / Q000627:therapeutic use*; D017602:Lithotripsy, Laser / Q000009:adverse effects* / Q000379:methods*; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D018666:Ureteroscopy / Q000009:adverse effects* / Q000379:methods*
references: Urol Res. 2010 Feb;38(1):1-5
references: 19921165
references: Urol J. 2008 Spring;5(2):67-73
references: 18592456
references: Eur Urol. 2007 Dec;52(6):1751-7
references: 17459573
references: J Urol. 2001 Aug;166(2):538-40
references: 11458062
references: J Endourol. 2006 Mar;20(3):179-85
references: 16548724
references: J Urol. 2007 Jun;177(6):2300-5
references: 17509344
references: BJU Int. 2005 May;95(7):1049-52
references: 15839930
references: Urol Int. 2010;85(3):320-3
references: 20664176
references: J Endourol. 2007 Apr;21(4):397-400
references: 17451329
references: J Endourol. 2005 Mar;19(2):151-8
references: 15798409
references: Urology. 2013 May;81(5):1047-51
references: 23465154
references: J Endourol. 2006 Apr;20(4):252-5
references: 16646651
references: J Urol. 2005 Sep;174(3):1072-4
references: 16094060
references: J Endourol. 2010 Aug;24(8):1273-7
references: 20420550
references: J Endourol. 2007 Mar;21(3):305-9
references: 17444776
references: Urol Int. 2009;82(3):341-5
references: 19440025
references: Lasers Surg Med. 1992;12(4):353-63
references: 1386643
references: J Endourol. 2008 Feb;22(2):257-60
references: 18294030
references: Int J Urol. 2013 Jun;20(6):616-21
references: 23163835
references: Lasers Surg Med. 1999;25(5):389-95
references: 10602130
references: J Urol. 2011 Sep;186(3):1035-40
references: 21784482
references: J Urol. 1998 Jan;159(1):17-23
references: 9400428
references: Urol Int. 2013;91(3):357-62
references: 23735605
references: World J Urol. 2011 Dec;29(6):719-23
references: 21079969
references: J Urol. 2000 Sep;164(3 Pt 2):1089-93
references: 10958749