Ballistic ureteroscopic lithotripsy in prepubertal patients: a feasible option for ureteral stones

OBJECTIVE: To evaluate the role of ballistic ureteroscopic lithotripsy in children with ureteral stones. MATERIALS AND METHODS: Children under 14 years with ureteral stones were treated with ureteroscopy in a 5-year period in our institution. RESULTS: Twenty-three procedures were performed in 20 children. Mean surgical time, age and stone size were 31 min. (15 - 120min.), 11 years. (4-13 years), 5.3 mm (3-10 mm) respectively. Three patients underwent two ballistic ureteroscopic lithotripsy each. There were 22 successful procedures (96 percent) and a 100 percent stone-free rate per patient. Complications (mucosal tear) occurred in 2 procedures (8 percent) without extravasation of contrast media on retrograde pyelogram and their follow-up was uneventful. CONCLUSION: Ureteroscopic ballistic lithotripsy is a feasible option for ureteral stones in prepubertal patients, with high stone-free rate and few complications.

Indications for percutaneous nephrostomy in patients with obstructive uropathy due to malignant urogenital neoplasias

INTRODUCTION: Urogenital neoplasias frequently progress with obstructive uropathy due to local spreading or pelvic metastases. The urinary obstruction must be immediately relieved in order to avoid deterioration in these patients. The percutaneous nephrostomy is a safe and effective method for relief the obstruction; however the indications of such procedures have been questioned in patients with poor prognosis. MATERIAL AND METHODS: A retrospective study was performed with 43 patients (29 female and 14 male) with urogenital neoplasias who were undergoing percutaneous nephrostomy during a 54-month period. The median age was 52 years. The primary tumoral site was the uterine cervix in 53.5 percent of patients, the bladder in 23.3 percent, the prostate in 11.6 percent and other sites in 11.6 percent. RESULTS: Postoperative complications occurred in 42.3 percent of the patients. There was no procedure-related mortality. Thirty-nine per cent of the patients died during the hospitalization period due to advanced neoplasia. The mortality rate was higher in patients with prostate cancer (p = 0.006), in patients over 52 years of age (p = 0.03) and in those who required hemodialysis before the procedure (p = 0.02). Thirty-two per cent of the patients survived long enough to undergo some form of treatment focused on the primary tumor. The survival rate was 40 percent at 6 months and 24.2 percent at 12 months. The percentage of the lifetime spent in hospitalization was 17.7 percent. The survival rate was higher in patients with neoplasia of the uterine cervix (p = 0.007) and in patients with 52 years of age or less (p = 0.008). CONCLUSION: Morbidity was high in this patient group; however, the majority of patients could be discharged from hospital and followed at home. Patients under 52 years of age and patients with neoplasia of the uterine cervix benefited most from the percutaneous nephrostomy when compared to patients with hormone therapy-refractory prostate cancer, bladder cancer or over 52 years of age.