ABSTRACT
BACKGROUND: Urinary stones disease is becoming more common not only in adults but also in children. Most cases are resolved with extracorporeal shock wave lithotripsy, but miniaturization of endoscopes has increased the use of ureteroscopy in resolving ureteral stones, most notably in children. CASE PRESENTATION: This presentation focuses on two cases of microureteroscopy. In both cases, the presence of lithiasis in the pelvic ureter was suspected to be the cause of ureter hydronephrosis, and a microureteroscopy was performed for treatment purposes. MicroPerc set 4.85F sheath was used to explore the pelvic ureter, thus avoiding the need to dilate the ureteral meatus or having to use the safety guide. Patients did not require a postoperative stent and were discharged within 24 hours of the procedure. CONCLUSION: Use of microureteroscopy proved satisfactory in the two cases of children and it allows diagnosis and treatment of ureteral pathology in pediatric patients.
ABSTRACT
PURPOSE: We determined the incidence of infectious complications (asymptomatic bacteriuria, urinary tract infection and urosepsis) in patients without associated risk factors treated with extracorporeal shock wave lithotripsy. MATERIALS AND METHODS: We performed an observational, prospective cohort study between October 2010 and June 2013. We included all patients without risk factors who were treated with extracorporeal shock wave lithotripsy for kidney or ureteral lithiasis. All patients underwent urine culture 5 days before the procedure. Another urine culture was performed 7 days after lithotripsy. No patient received antibiotics. RESULTS: Initially 366 patients with a mean ± SD age of 53 ± 13 years were enrolled in the study. A total of 64 patients (17.5%) underwent extracorporeal shock wave lithotripsy with a previously placed Double-J® stent. After lithotripsy urine culture was positive in 20 patients (5.8%), of whom 4 (1.2%) presented with symptomatic urinary infection and the remaining 4.6% showed no symptoms. Urosepsis did not develop in any case. In our study patient age was an independent risk factor for bacteriuria after lithotripsy. CONCLUSIONS: The incidence of infectious complications after extracorporeal shock wave lithotripsy in patients without risk factors is low. This leads us to conclude that without defined risk factors antibiotic prophylaxis is not justified. Also, elderly patients were more at risk for bacteriuria after extracorporeal shock wave lithotripsy and, thus, for a possible infectious complication.
