ELECTROHYDRAULIC VERSUS HOLMIUM LASER LITHOTRIPSY FOR BLADDER AND URETHRAL STONES IN CHILDREN

Objective: To compare the efficacy and safety of electrohydraulic and Holmium laser lithotripsy in the treatment of bladder and/or urethral stones in children. Patients and Methods: Between January 2000 and January 2006, 112 children (102 boys and 10 girls) aged between 2 and 13 years presented to our department with vesical (n=72) and urethral (n=40) stones. Previous surgery for bladder stones was reported in 28/112 (25%) cases. The stone burden ranged from 4-22 mm. The stones were radiolucent in 12 (10.7%) cases. Multiple bladder and combined urethral and vesical stones were recorded in 14 (12.5%) cases. The children were divided into two groups according to the treatment modality: 50 children (Group A) were treated by electrohydraulic lithotripsy (EHL) using either pediatric cystoscopes or the short ureteroscope, 7 F, while in 62 children (Group B) Holmium laser was used through a 7.5 F pediatric endoscope without any modification. Follow up range was 1-1.5 years. Results: In Group A, disintegration was successful in 48/50 (96%) cases. The mean operative time was 18.3 minutes. The urethral catheter was maintained for 24-72 hours (mean 36 hours). Conversion into open surgery was necessary in two cases. No other major operative or postoperative complications were encountered. In Group B, complete disintegration was achieved in all cases including impacted urethral stones. The mean operative time was 15.7 minutes. The urethral catheter was left for one day only in 36 (58.1%) cases. Conclusions: In our series, Holmium laser lithotripsy used for the treatment of bladder or urethral stones in children caused no complications and achieved slightly better results than electrohydraulic lithotripsy. Nevertheless, electrohydraulic lithotripsy remains an effective and a viable option despite its rare - yet sometimes serious complications.