Transureteral Lithotripsy of Ureteral Calculi in Children with Holmium: Yttrium Aluminium Garnet Laser

INTRODUCTION: Surgical management of pediatric urinary calculi evolved dramatically over the past two decades. However, with the miniaturization of equipment and with improvisation of endourologic techniques, access to the entire pediatric urinary system is possible. Ho: YAG laser provides more maneuverability during transuretereal lithotripsy (TUL) than the pneumatic system which uses a metal probe, especially when used in pediatrics urinary systems. In this study, we report our experience about treatment of pediatric ureteral stone with HO: YAG laser.METHODS: Between 2008 -2011, 41 children ≤ 12 years of age with ureteral stones were included in our study. Using K.U.B, sonography, and intravenous urogram, diagnoses were established for all patients. 6F or 8F wolf semi rigid ureteroscope was used for ureteroscopy under general anesthesia and stone fragmentation was implemented by Ho: YAG laser. For the evaluation of stone free rate, we used the following day & week confirmatory KUB, and sonograms additional to the direct visualization of the ureter during ureteroscopy. The patients were scheduled to be followed by control sonograms 2 weeks and 2 months after the operation to rule out past operational ureteral stenosis.RESULTS: From our 40 patients whose ages were in the range of 8 months and twelve years of old with a mean age 3.5 years, 18 patients (45%) had distal ureteral stones, ten (25%) in mid ureter, and twelve of them (30%) had the stone in their proximal ureter. The mean diameter of stones was 9.3 mm (3.5-11 mm). Three patients had encrusted double j stents (DJS). Our overall stone free rate was 89.35% at the end of 1 week. The complications were fever in 5 patients (12.5%) and ureteral stricture due to ureteral perforation in one patient, while one patient had long hospital stay due to refractory pain and nausea. The mean time of post-surgical hospital stay was 42 hours, while for only 20% of patients (8 patients) and in the rest of patients (30 patients) this period was only 24hours.DISCUSSION: Endoscopic lithotripsy in children has gradually become a major technique for the treatment of ureteral stones. This progression has been on the basis of the development of appropriate endoscopes and effective working instruments. The stone-free rate following urteroscopic lithotripsy for ureteral stones has been reported in as high as 98.5-100%. In this study, overall stone free rate was 89.35%. The complications after ureteroscopic laser lithotripsy are uncommon and usually related to passage of the ureteroscope than from laser action. Fever was the most common complication which occurred in 5 (12.5%) of our patients despite the fact that all patients were hospitalized the day before the procedure and were under parenteral antibiotic therapy. Postoperative stenting after ureteroscopic lithotripsy remained controversial. Most children were able to tolerate the attached string and the stent could be removed 5-7 days after without the use of an additional anesthetic. We used suitable ureteral catheters for 24 hours in all patients.CONCLUSION: Although HO: YAG laser lithotripsy is safe in children, we need more controlledtrials to show the best method of lithotripsy in pediatric ureteral stones

Green Light Photo Selective Vaporization of the Prostate vs. Transurethral Resection of Prostate for Benign Prostatic Hyperplasia

INTRODUCTION: Green light photo selective vaporization of the prostate (PVP) is a minimally invasive method of treatment for clinical benign prostatic hyperplasia with fewer side effects. The aim of this study is to evaluate the safety, effectiveness and cost analysis of PVP compared with transurethral resection of prostate.METHODS: A systematic search was done in Cochrane, TRIP database, MEDLINE, NHS EED, NIHR HTA, CRD, Health star database, Pro Quest, Psycoinfo and Google Scholar to find randomized control trials, systematic reviews and HTA reports. The searched keywords were Green light laser (PVP or KTP) and prostate. The cost analysis was done by the perspective of society and providers.RESULTS: Complication rate in 12 included evidences ranged from 0-9.3%. The complication rate of TUR-P (Transurethral Resection of Prostate) was more than PVP. Changing in flow rate reducing residual urine, improving patients’ symptoms and QOL (Quality of life), and operative outcome length of operation varied from no significant to significant differences in favor of TURP. Unit cost in both social and provider view was significantly high in PVP in comparison with TURP. Increasing the number of patients did not change the cost analysis.CONCLUSION: PVP is a safe method for treatment of clinical BPH, but there is a lack of evidence for the evaluation of effectiveness. Overall, the unit cost for PVP was significantly more than TURP; for this reason this method could not be conducted in very wide indications, because of high cost

The Comparison of Apotel plus Low Dose of Morphine and Full Dose of Morphine in Pain ‎Relief in Patients with Acute Renal Colic

Background: Renal colic is an acute flank pain which may radiate to the groin, lower abdomen, or external genitalia due to the passage of a urinary stones. Pain management is the most important task in emergency wards when a patient with renal colic attends. This study aims to compare intravenous acetaminophen plus a low dose of morphine with a full dose of morphine in renal colic. Methods: In present randomized clinical trial, 100 patients with confirmed renal colic were recruited from the emergency ward of Imam Reza Teaching Hospital affiliated to Tabriz University of Medical Sciences, Tabriz, Iran, during a one-year period. These patients randomly received either intravenous acetaminophen (Apotel, 1 g) plus a low dose of morphine (n = 50), or a high dose of morphine (5 mg) (n = 50). Visual analogue scale was used for reporting pain during 35 minutes. Side effects and rescue analgesic demand were recorded after 30 minutes. Findings: The two groups were matched for the patients' age and gender. Intra-group analysis showed significant gradual decreases in pain intensity after 35 minutes for both groups. Inter-group analysis, however, did not show a significant difference between the two groups in this regard. There was no significant difference between the two groups in terms of side effects. The rate of rescue analgesic demand was 36% in the first and 40% in the second group (P = 0.68). Conclusion: According to the results study, Apotel plus a low dose of morphine is at least as effective and safe as a full dose of morphine in patients with renal colic

Transcutaneous Ultrasound Guided Nephrolithotomy: The First Report from Iran

Purpose: To evaluate the safety and efficacy of transcutaneous ultrasound guided nephrolithotomy.Materials and Methods: From December 1999 to December 2000, 12 patients with renal stone were selected for PCNL. Six patients had failed ESWL and the remainder had multiple and large stones in pelvis and lower calyx. Ultrasonography was used in 11 patients during the entrance to the system and dilatation of the tract. Entrance to the system was impossible in one case for which open surgery with dorsal lumbotomy was performed. Results: The stone was removed by just one session of PCNL in 8 and the residual stone was less than 1 cm in the 3 other cases. Repeated PCNL from the same tract was performed in one case and ESWL was carried out in the other 2 cases. After three months, all of the 11 patients were stone free.Conclusion: It seems that ultrasonography could replace fluoroscopy in patients with dilated collective urinary system and a single large stone in calyx or pelvis.</p

The Comparison of Apotel plus Low Dose of Morphine and Full Dose of Morphine in Pain Relief in Patients with Acute Renal Colic

Abstract Background: Renal colic is an acute flank pain which may radiate to the groin, lower abdomen, or external genitalia due to the passage of a urinary stones. Pain management is the most important task in emergency wards when a patient with renal colic attends. This study aims to compare intravenous acetaminophen plus a low dose of morphine with a full dose of morphine in renal colic. Methods: In present randomized clinical trial, 100 patients with confirmed renal colic were recruited from the Emergency Ward of Imam Reza Teaching Hospital affiliated to Tabriz University of Medical Sciences, Iran, during a one-year period. These patients randomly received either intravenous acetaminophen (Apotel, 1 g) plus a low dose of morphine (n = 50), or a high dose of morphine (5 mg) (n = 50). Visual analogue scale (VAS) was used for reporting pain during 35 minutes. Side effects and rescue analgesic demand were recorded after 30 minutes. Findings: The two groups were matched for the patients' age and gender. Intra-group analysis showed significant gradual decreases in pain intensity after 35 minutes for both groups. Inter-group analysis, however, did not show a significant difference between the two groups in this regard. There was no significant difference between the two groups in terms of side effects. The rate of rescue analgesic demand was 36% in the first and 40% in the second group (P = 0.68). Conclusion: According to the results study, Apotel plus a low dose of morphine is at least as effective and safe as a full dose of morphine in patients with renal colic. Keywords: Renal colic, Intravenous acetaminophen, Morphin

Treatment of ureteral stones: A prospective randomized controlled trial on comparison of Ho:YAG laser and pneumatic lithotripsy

Objectives: To study the treatment of ureteric stones by HO:YAG laser lithotripsy and pneumatic lithotripsy and to evaluate the results of the two treatment modalities to assess effectiveness and complications. Materials and Methods: Over 1-year period, a total of 79 patients with 82 ureteral stones were randomized into two groups. In group 1 (39 cases with 41 ureteral stones) ureteroscopic HO:YAG laser lithotripsy was performed using a rigid 8 Fr-ureteroscope (LL group). In group 2 (40 cases with 41 ureteral stones) pneumatic lithotripsy was performed in like manner. Efficacy safety and complications in both groups were analyzed. Results: A total of 79 patients with 82 calculi were treated. Two cases in LL group and one in PL group had bilateral ureteral stones. Mean stone size was 12.07 mm in LL group and 10.2 mm in PL group. Stones located in lower ureter in 30 cases on LL group and 29 cases in PL group. Proximal migration of stone occurred in 1 case on LL group and in 3 cases on PL group. Successful fragmentation occurred in 37 cases on LL group and in 30 cases on PL group. Stone-free rate after 1 month in the base of Kidney Ureter Bladder (KUB) and sonography was 95% in LL group and 80.5% in PL group. Ureteral perforation, urinoma, and urosepsis were not seen in both groups. Conclusion: HO:YAG laser has advantages over PL in high efficacy of stone fragmentation and a low-retrograde migration of ureteral stone treatment. Other complication of ureteral stone treatment with LL and PL are the same and very rare