Keywords : urolithiasis
Iraqi Postgraduate Medical Journal,
2017, Volume 16, Issue 1, Pages 30-34
Pediatric vesical stones constitute 30% of all urinary tract stones in the developing countries. Management of pediatric urolithiasis has evolved from open surgery to minimally invasive techniques
To evaluate the efficacy and safety of using pneumatic lithotripsy in the treatment of vesical stone in pediatric age group.
PATIENTS AND METHODS:
Forty children (2 female and 38 male) with bladder calculi were evaluated in this prospective study and managed by transurethral pneumatic cystolithotripsy at the department of urology in Al-Ramadi Teaching Hospital during the period January 2010 through December2012. The age ranged between 2 years and 10 years with a mean age of 4.6 years. Bladder stone size ranged from 8mm to 17mm ,plain X-ray kidney, ureter and bladder (KUB) revealed that 28 patient's calculi were radiopaque and 12 patient's calculi were radiolucent , History and physical examination were performed. Laboratory investigations included complete blood count, blood urea, serum creatinine and urine analysis. Radiological examination included plain X-ray kidney, ureter and bladder (KUB) ,ultrasound and Excretory urogram (EU). transurethral pneumatic lithotripsy of bladder stone was done using semi rigid 9FR ureteroscope, after initial cystoscopy, Stone was fragmented with pneumatic lithoclast probe (3mm tip, storz). After completing the procedure 8-12 FR urethral Foley catheter was passed. Foley catheter was removed after 24-72 hours .
After one session of cystolithoclast, 92.5% (37) children became stone free. The mean operative time was 41.575 minutes with a range of (35-75 min).In this study the complications included significant hematuria in 5 patients (12.5%), urine retention in one patient (2.5%), and residual stone in 3 patients (7.5%) .
Pneumatic lithotripsy using ureteroscope appears to be an effective and safe treatment method for bladder stone in children.
Iraqi Postgraduate Medical Journal,
2016, Volume 15, Issue 3, Pages 334-337
Renal stone disease is common in Iraqi population and percutaneous nephrolithoyomy present a minimal access for large stone a substitute for traditional open surgery
We are presenting our first experience in percutaneous nephrolithotomy )PCNL( in terms of renal access, stone free and to evaluate the other aspects such as the need of auxiliary procedures in a center without prior experience in this field.
MATERIALS AND METHODS:
We evaluate all the PCNL performed in period of two year. A series of perioperative and post-operative details were recorded. All PCNL were performed in prone position.
The first 55 PCNL cases were included in the study. Out of 55 patients, 16 were women and 39 men. Their mean age was 35.5 years (range 11-65) and means stone diameter were 23.5 mm ± 8.9. A successful renal access achieved in 87.3 % (48) cases with stone fragmentation. Procedures were performed over two year Dec.2013-Dec. 2015. Of fifty five patients 4 cases with single functioning kidney, and eleven cases with PCNL on same side of previous scar of pyelolithotomy. Stone free rate was 82%. Co morbidities included 8 hypertensive, 3 diabetics, one systemic lupus erythematosus and two with elevated blood urea.
Morbidity and complications following PCNL are dominated by access failure in 12.7 % (n= 7); intraoperative bleeding in 3.6 % (n=2), urinary leakage in one patient, ureteric colic in 5.4 % (n=3) hydrothorax 1.8 % (n=1). None of these patients experienced post-operative bleeding, No mortality
PCNL can be learned by urologists who do not have the support of an experienced colleague without endangering patient safety.