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MINIMALLY INVASIVE TREATMENT OF UROLITHIASIS IN CHILDREN
Turakulov Zoirjon Shokirovich
Assistant of Children's Surgery Department for treatment
Andijan State Medical Institute
Abstract.
Contact and remote lithotripsy for urolithiasis of various localizations is a
promising alternative to traditional “open” operations in children of all age groups. Provided
that the children’s hospital has adequate technical equipment, world standards for the
treatment of urolithiasis, adopted in adult practice, can be effectively used in pediatric
urology.
Kеywоrds:
urolithiasis, method, treatment, diagnosis.
INTRОDUСTIОN
Ureterocele is a pathological intravesical formation, which is an intramural section of the
ureter dilated in the form of a cyst, which is usually caused by obstruction of the orifice and
is accompanied by ureterohydronephrosis. Orthotopic ureterocele occurs in a non-duplicated
ureter, the orifice of which is located in the usual place, ectopic ureterocele always
corresponds to an additional ureter of a double kidney. Depending on the urodynamic
disorders of the upper urinary tract, three degrees of ectopic ureterocele are distinguished.
Depending on the degree of ectopia of the additional orifice, ureterocele can be vesical,
urethral and prolapsed. The latter is often the cause of infravesical obstruction. The
incidence rate is 1:3500 newborns, the ratio of boys to girls is 1:4. Antenatal diagnosis of
ureterocele is based on the use of sonography. The sensitivity of the method is from 60 to
80%, diagnosis is possible from the 16th week of gestation. Diagnostic markers are the
presence of a cystic formation in the lumen of the bladder, dilation of the ureter and
collecting system of the kidney, as well as oligohydramnios in case of complication of
infravesical obstruction [1].
MАTЕRIАLS АND MЕTHОDS
After the birth of the child, the pathology can be detected by ultrasound screening, which
visualizes the intravesical anechoic formation. Among the radiopaque methods of
examination, the leading role is given to excretory urography, which allows to determine the
filling defect of the bladder corresponding to ureterocele, as well as the dilated ureter and the
dilated calyceal-pelvic system of the affected kidney or its additional segment. An indication
for surgical treatment of ureterocele in the early stages is the presence of obstructive
syndrome. Dissection of the ureterocele is performed at the base with the formation of a free
outflow of urine from the ureter. Operations can be performed by the open method with
additional antireflux protection according to Gregoire. The operation of choice, in our
opinion, regardless of the age group, is endoscopic correction. The latter is performed using
diathermocoagulation or high-energy laser against the background of filling the bladder with
a 5% glucose solution. The criterion for the effectiveness of the neostoma in this case is the
possibility of passing a 9 Ch cystoscope through it. In the case of preserved renal function,
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dissection of the ureterocele is a method of radical correction. In the absence of function of
the renal segment, this operation is regarded as the first stage of surgical correction of the
malformation in order to decompress the urinary tract and prevent recurrent infection. If the
function of the affected segment does not improve within 6-12 months,
heminephrureterectomy is performed as the second stage [2].
RЕSULTS АND DISСUSSIОN
Ureteroscopy involves endoscopic insertion through the urethra and bladder into the ureter
to visualize and extract or fragment stones using laser lithotripsy. With advancements in
miniaturized ureteroscopes, URS is increasingly used in pediatric patients, especially for
distal and mid-ureteral stones.
Advantages:
Direct visualization and access
High stone-free rates
Useful for impacted stones
Complications:
Ureteral trauma or stricture
Post-operative hematuria
Need for stent placement
Retrograde Intrarenal Surgery (RIRS)
RIRS extends the URS approach into the renal collecting system using flexible
ureteroscopes. It is especially useful for treating intrarenal stones that are difficult to manage
with ESWL. Pediatric adaptations include smaller-diameter scopes and laser energy
adjustments to protect renal tissues.
Indications:
Stones in lower pole calyces
Failed ESWL
Anatomic abnormalities
Considerations:
Requires high expertise
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Pre-operative stenting may be necessary to dilate the ureter
PCNL is reserved for large (>2 cm) or complex renal calculi. Through a small incision in the
back, instruments are passed directly into the kidney to fragment and remove stones. In
children, mini-PCNL or micro-PCNL has been developed to minimize trauma [3].
Advantages:
High success rates for large stones
Fewer sessions needed than ESWL
Risks:
Bleeding
Injury to surrounding organs
Need for post-op nephrostomy tube
Successful stone removal must be followed by preventive care. This includes metabolic
evaluation, dietary modification (increased hydration, reduced sodium and oxalate intake),
and monitoring with ultrasound to detect recurrence. Long-term follow-up is essential due to
high recurrence rates in pediatric urolithiasis [4].
СОNСLUSIОN
Children with congenital ureterocele are subject to early surgical treatment in order to
relieve the renal collecting system and prevent further progressive damage. Minimally
invasive intervention is the operation of choice in newborns regardless of the type, nature
and degree of ureterocele. In the future, all children after correction of the defect in the early
period are subject to mandatory dynamic observation and control examination.
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