title: Holmium laser lithotripsy with semi-rigid ureteroscopy: a first-choice treatment for impacted ureteral stones in children?
abstract: BACKGROUND
  We aimed to assess the effectiveness of semi-rigid ureteroscopy and holmium laser lithotripsy in the treatment of impacted ureteral stones in children.
  
  
  METHODS
  We evaluated a total of 32 children under the age of 18 years treated with ureteroscopic holmium laser lithotripsy for impacted ureteral stones between January 2005 and July 2013. Their stone-free state was defined as the absence of any residual stone on radiologic evaluation performed 4 weeks postoperatively. Complications were evaluated according to the modified Clavien classification.
  
  
  RESULTS
  The mean patient age was 9.5±5.1 years (range 1-18 years). Seven (21.8%) of the stones were located in the proximal ureter, 9 (28.2%) were in the mid-ureter, and 16 (50%) were in the distal ureter. The mean stone size was calculated as being 10.46±3.8 mm2 (range 5-20). The stone-free rate was 93.75% (30/32 patients) following primary URS. Additional treatment was required for only 2 (6.25%) of the patients. After the procedure, a D-J stent was placed in all the patients. The total complication rate was 15.6% (5 patients). The 10 total complications in these 5 patients were 5 (15.6%) Grade I, 1 (3.1%) Grade II, 2 (6.25%) Grade IIIa, and 2 (6.25%) Grade IIIb. The mean follow-up period was 16.5 months (range 3-55).
  
  
  CONCLUSIONS
  For the treatment of impacted ureteral stones in children, holmium laser lithotripsy with semi-rigid ureteroscopy, with its low retreatment requirement and acceptable complication rates, is an effective and reliable method in experienced and skilled hands as a first-choice treatment approach.
authors.affiliation: Department of Urology, School of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: Senol
authors.initials: S
authors.lastname: Adanur
authors.affiliation: Department of Urology, Akçaabat Haçkalı Baba Hospital, Trabzon, Turkey.
authors.forename: Hasan Riza
authors.initials: HR
authors.lastname: Aydin
authors.affiliation: Department of Urology, School of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Ozkaya
authors.affiliation: Department of Urology, School of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: Tevfik
authors.initials: T
authors.lastname: Ziypak
authors.affiliation: Department of Urology, School of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: Ozkan
authors.initials: O
authors.lastname: Polat
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003710:Demography; D005260:Female; D006801:Humans; D007223:Infant; D053844:Lasers, Solid-State / Q000009:adverse effects; D017602:Lithotripsy, Laser / Q000009:adverse effects; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography; D014514:Ureteral Calculi / Q000000981:diagnostic imaging / Q000628:therapy*; D018666:Ureteroscopy