urovestВестник урологииUrology Herald2308-6424Rostov State Medical University10.21886/2308-6424-2022-10-4-171-178urovest-618Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL CASESКонтактная уретеролитотрипсия крупного конкремента мочеточника у ребёнка 3-х летContact ureterolithotripsy of a giant ureteral stone in a 3-year-old childhttps://orcid.org/0000-0001-8142-200XКлюкаИ. В.KlyukaI. V.

Клюка Игорь Васильевич — кандидат медицинских наук, ассистент кафедры детской хирургии и ортопедии РостГМУ Минздрава России; детский уролог-андролог детского уроандрологического отделения ОДКБ.

344015, Ростов-на-Дону, ул. 339-й Стрелковой дивизии, д. 14; 344022, Ростов-на-Дону, пер. Нахичеванский, д. 29

Igor V. Kliuka — M.D., Cand.Sc.(Med), Assist.Prof., Dept. of Pediatric Surgery and Orthopedics, Rostov State Medical University; Pediatric Urologist and Andrologist, Pediatric Urological and Andrological Division, Rostov-on-Don Regional Children's Clinical Hospital.

14 339th Strelkovoy Divisii St., Rostov-on-Don, 344015; 29 Nakhichevanskiy Ln., Rostov-on-Don, 344022

kluka@list.ruhttps://orcid.org/0000-0001-9145-8671СизоновВ. В.SizonovV. V.

Сизонов Владимир Валентинович — доктор медицинских наук, профессор, профессор кафедры урологии и репродуктивного здоровья человека (с курсом детской урологии-андрологии) РостГМУ Минздрава России; заведующий детским уроандрологическим отделением ОКДБ.

344015, Ростов-на-Дону, ул. 339-й Стрелковой дивизии, д. 14; 344022, Ростов-на-Дону, пер. Нахичеванский, д. 29

Vladimir V. Sizonov — M.D., Dr.Sc.(Med), Full Prof., Prof., Dept. of Urology and Human Reproduc-tive Health (with Pediatric Urology and Andrology Course), Rostov State Medical University; Head, Pediatric Urological and Andrological Division, Rostov-on-Don Regional Children’s Clinical Hospital.

14 339th Strelkovoy Divisii St., Rostov-on-Don, 344015; 29 Nakhichevanskiy Ln., Rostov-on-Don, 344022

vsizonov@mail.ruhttps://orcid.org/0000-0003-0674-9429БелоусовИ. И.BelousovI. I.

Белоусов Игорь Иванович — доктор медицинских наук, доцент, профессор кафедры урологии и репродуктивного здоровья человека (с курсом детской урологии-андрологии) РостГМУ Минздрава России.

344022, Ростов-на-Дону, пер. Нахичеванский, д. 29

Igor I. Belousov —M.D., Dr.Sc.(Med), Assoc.Prof.(Docent), Prof., Dept. of Urology and Human Reproductive Health (with Pediatric Urology and Andrology Course), Rostov State Medical University.

29 Nakhichevanskiy Ln., Rostov-on-Don, 344022

belrost_dept@mail.ruhttps://orcid.org/0000-0003-4177-6772ВигераВ. В.VigeraV. V.

Вигера Владимир Васильевич — ординатор кафедры урологии и репродуктивного здоровья человека (с курсом детской урологии-андрологии) РостГМУ Минздрава России.

344022, Ростов-на-Дону, пер. Нахичеванский, д. 29

Vladimir V. Vigera — Resident, Dept. of Urology and Human Reproductive Health (with Pediatric Urology and Andrology Course), Rostov State Medical University.

29 Nakhichevanskiy Ln., Rostov-on-Don, 344022

vigeravladimir@yandex.ruОбластная детская клиническая больница; Ростовский государственный медицинский университет Минздрава РоссииРоссияRostov-on-Don Regional Children's Clinical Hospital; Rostov State Medical UniversityRussian FederationРостовский государственный медицинский университет Минздрава РоссииРоссияRostov State Medical UniversityRussian Federation202226122022104171178Copyright © Клюка И.В., Сизонов В.В., Белоусов И.И., Вигера В.В., 20232023Клюка И.В., Сизонов В.В., Белоусов И.И., Вигера В.В.Klyuka I.V., Sizonov V.V., Belousov I.I., Vigera V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.urovest.ru/jour/article/view/618

Случаи лечения гигантских камней мочеточника у детей раннего возраста являются редкими клиническими наблюдениями с вариабельной хирургической тактикой. В настоящем наблюдении представлен случай эффективного и безопасного эндоскопического лечения гигантского камня мочеточника у ребёнка раннего возраста. Пациент — ребёнок 3-х лет, мужского пола, при обследовании по поводу болей в животе и лихорадки диагностирован конкремент до 30 мм дистального отдела левого мочеточника, осложнённый уретерогидронефрозом. Первым этапом лечения выполнено стентирование мочеточника, при котором камень мигрировал в среднюю треть мочеточника. Вторым этапом лечения произведена контактная уретеролитотрипсия полуригидным уретероскопом 9 Ch («Richard Wolf» GmbH, Knittlingen, Germany) и пневматическим литотриптером Swiss LithoClast® 2 («E.M.S. Electro Medical Systems» S.A., Nyon, Suisse), стентирование мочеточника внутренним стентом (2-сторонний PigTail, 4.5 Ch). Третьим этапом в отсроченном периоде проведена дистанционная литотрипсия «каменной дорожки» c помощью Dornier Compact Sigma («Dornier MedTech» GmbH, Weßling, Germany) и удаление стента. По данным контрольного обследования, резидуальные конкременты не выявлены. Осложнений лечения не зарегистрировано. Применение этапного мультимодального лечения гигантского камня мочеточника привело к полной элиминации последнего; эндоскопическая оценка мочеточника позволила выявить сопутствующую патологию проксимального отдела мочеточника, требующую своей оценки в отсроченном периоде; стентирование мочеточника способствовало нормализации функции почки. Достигнутый результат отражает максимальную эффективность и высокий профиль безопасности применённой методики хирургии.

Giant ureteral stones in young children are extremely rare and their surgical treatment tactics are variable. The present case describes a case of effective and safe endoscopic treatment of giant ureteral stones in a young child. The patient is a 3-year-old male child. Examination findings of abdominal pain and fever verified a left distal ureteric stone up to 30 mm complicated by ureterohydronephrosis. The first treatment stage was ureteral stenting, in which the stone migrated to the middle ureteral third. The second treatment stage was contact ureterolithotripsy with a 9 Ch semi-rigid ureteroscope («Richard Wolf» GmbH, Knittlingen, Germany) and Swiss LithoClast® 2 pneumatic lithotripter («E.M.S. Electro Medical Systems» S.A., Nyon, Suisse), ureteral stenting (2-way PigTail, 4.5 Ch). The third treatment stage in the delayed period was extracorporeal shockwave lithotripsy of the steinstrasse using the Dornier Compact Sigma («Dornier MedTech» GmbH, Weßling, Germany) and stent removal. Residual stones were not revealed according to the follow-up examination. No treatment complications were registered. The multimodal staged treatment of a giant ureteral stone resulted in its complete elimination. Next-step ureteral endoscopy made it possible to identify concomitant pathology of the proximal ureter, which required its evaluation in the delayed period. Ureteral stenting contributed to the restoration of renal function. The result achieved reflects the maximum efficiency and high safety of the surgical technique applied.

уретеролитиазкрупный камень мочеточникамультимодальное лечениеДУВЛуретероскопияконтактная литотрипсияureterolithiasisureteral stonegiantlargemultimodal treatmentureteroscopycontact lithotripsyESWLReferencesГудков Р.А., Слободянюк О. Мочекаменная болезнь у детей. Российский педиатрический журнал. 2021;24(4):253. EDN: NDPIDJGudkov R.A., Slobodyanyuk O. Urolithiasis in children. Russian pediatric journal. 2021;24(4):253. (In Russ.) EDN: NDPIDJGadzhiev N, Prosyannikov M, Malkhasyan V, Akopyan G, Somani B, Sivkov A, Apolikhin O, Kaprin A. Urolithiasis prevalence in the Russian Federation: analysis of trends over a 15-year period. World J Urol. 2021;39(10):3939-3944. https://doi.org/10.1007/s00345-021-03729-yGadzhiev N, Prosyannikov M, Malkhasyan V, Akopyan G, Somani B, Sivkov A, Apolikhin O, Kaprin A. Urolithiasis prevalence in the Russian Federation: analysis of trends over a 15-year period. World J Urol. 2021;39(10):3939-3944. https://doi.org/10.1007/s00345-021-03729-yKim HW, Kim KD, Moon YT, Kim SC. A giant ureteral stone. J Korean Med Sci. 1995;10(1):48-50. https://doi.org/10.3346/jkms.1995.10.1.48Kim HW, Kim KD, Moon YT, Kim SC. A giant ureteral stone. J Korean Med Sci. 1995;10(1):48-50. https://doi.org/10.3346/jkms.1995.10.1.48Resorlu B, Kara C, Resorlu EB, Unsal A. Effectiveness of ultrasonography in the postoperative follow-up of pediatric patients undergoing ureteroscopic stone manipulation. Pediatr Surg Int. 2011;27(12):1337-41. https://doi.org/10.1007/s00383-011-2979-0Resorlu B, Kara C, Resorlu EB, Unsal A. Effectiveness of ultrasonography in the postoperative follow-up of pediatric patients undergoing ureteroscopic stone manipulation. Pediatr Surg Int. 2011;27(12):1337-41. https://doi.org/10.1007/s00383-011-2979-0Skolarikos A, Neisius A, Petřík A, Somani B, Thomas K, Gambaro G. Urolithiasis. In: EAU Guidelines. Edn. presented at the EAU Annual Congress Amsterdam, 2022. ISBN 978-94-92671-16-5. URL: https://uroweb.org/guideline/urolithiasis/Skolarikos A, Neisius A, Petřík A, Somani B, Thomas K, Gambaro G. Urolithiasis. In: EAU Guidelines. Edn. presented at the EAU Annual Congress Amsterdam, 2022. ISBN 978-94-92671-16-5. URL: https://uroweb.org/guideline/urolithiasis/Torricelli FC, Monga M, Marchini GS, Srougi M, Nahas WC, Mazzucchi E. Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta - analysis of randomized controlled trials. Int Braz J Urol. 2016;42(4):645-54. https://doi.org/10.1590/S1677-5538.IBJU.2015.0696Torricelli FC, Monga M, Marchini GS, Srougi M, Nahas WC, Mazzucchi E. Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta - analysis of randomized controlled trials. Int Braz J Urol. 2016;42(4):645-54. https://doi.org/10.1590/S1677-5538.IBJU.2015.0696Lai S, Jiao B, Diao T, Seery S, Hu M, Wang M, Hou H, Wang J, Zhang G, Liu M. Optimal management of large proximal ureteral stones (>10 mm): A systematic review and meta-analysis of 12 randomized controlled trials. Int J Surg. 2020;80:205-217. https://doi.org/10.1016/j.ijsu.2020.06.025Lai S, Jiao B, Diao T, Seery S, Hu M, Wang M, Hou H, Wang J, Zhang G, Liu M. Optimal management of large proximal ureteral stones (>10 mm): A systematic review and meta-analysis of 12 randomized controlled trials. Int J Surg. 2020;80:205-217. https://doi.org/10.1016/j.ijsu.2020.06.025Shao Y, Wang DW, Lu GL, Shen ZJ. Retroperitoneal laparoscopic ureterolithotomy in comparison with ureteroscopic lithotripsy in the management of impacted upper ureteral stones larger than 12 mm. World J Urol. 2015;33(11):1841-5. https://doi.org/10.1007/s00345-015-1545-0Shao Y, Wang DW, Lu GL, Shen ZJ. Retroperitoneal laparoscopic ureterolithotomy in comparison with ureteroscopic lithotripsy in the management of impacted upper ureteral stones larger than 12 mm. World J Urol. 2015;33(11):1841-5. https://doi.org/10.1007/s00345-015-1545-0Wang Y, Zhong B, Yang X, Wang G, Hou P, Meng J. Comparison of the efficacy and safety of URSL, RPLU, and MPCNL for treatment of large upper impacted ureteral stones: a randomized controlled trial. BMC Urol. 2017;17(1):50. https://doi.org/10.1186/s12894-017-0236-0Wang Y, Zhong B, Yang X, Wang G, Hou P, Meng J. Comparison of the efficacy and safety of URSL, RPLU, and MPCNL for treatment of large upper impacted ureteral stones: a randomized controlled trial. BMC Urol. 2017;17(1):50. https://doi.org/10.1186/s12894-017-0236-0Kumar A, Vasudeva P, Nanda B, Kumar N, Jha SK, Singh H. A Prospective Randomized Comparison Between Laparoscopic Ureterolithotomy and Semirigid Ureteroscopy for Upper Ureteral Stones >2 cm: A Single-Center Experience. J Endourol. 2015;29(11):1248-52. https://doi.org/10.1089/end.2013.0791Kumar A, Vasudeva P, Nanda B, Kumar N, Jha SK, Singh H. A Prospective Randomized Comparison Between Laparoscopic Ureterolithotomy and Semirigid Ureteroscopy for Upper Ureteral Stones >2 cm: A Single-Center Experience. J Endourol. 2015;29(11):1248-52. https://doi.org/10.1089/end.2013.0791Jeong YB, Park JK, Kim HJ, Kim YG, Kim MK. Giant ureteral stone in a patient with a single functioning kidney: a case report. Clin Nephrol. 2011;75(6):547-9. https://doi.org/10.5414/cn106668Jeong YB, Park JK, Kim HJ, Kim YG, Kim MK. Giant ureteral stone in a patient with a single functioning kidney: a case report. Clin Nephrol. 2011;75(6):547-9. https://doi.org/10.5414/cn106668Wang Y, Chang X, Li J, Han Z. Efficacy and safety of various surgical treatments for proximal ureteral stone ≥10mm: A systematic review and network meta-analysis. Int Braz J Urol. 2020;46(6):902-926. https://doi.org/10.1590/S1677-5538.IBJU.2019.0550Wang Y, Chang X, Li J, Han Z. Efficacy and safety of various surgical treatments for proximal ureteral stone ≥10mm: A systematic review and network meta-analysis. Int Braz J Urol. 2020;46(6):902-926. https://doi.org/10.1590/S1677-5538.IBJU.2019.0550Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69(3):475-82. https://doi.org/10.1016/j.eururo.2015.07.041Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69(3):475-82. https://doi.org/10.1016/j.eururo.2015.07.041Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, Pace KT, Pais VM Jr, Pearle MS, Preminger GM, Razvi H, Shah O, Matlaga BR. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART II. J Urol. 2016;196(4):1161-9. https://doi.org/10.1016/j.juro.2016.05.091Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, Pace KT, Pais VM Jr, Pearle MS, Preminger GM, Razvi H, Shah O, Matlaga BR. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART II. J Urol. 2016;196(4):1161-9. https://doi.org/10.1016/j.juro.2016.05.091Gofrit ON, Pode D, Meretyk S, Katz G, Shapiro A, Golijanin D, Wiener DP, Shenfeld OZ, Landau EH. Is the pediatric ureter as efficient as the adult ureter in transporting fragments following extracorporeal shock wave lithotripsy for renal calculi larger than 10 mm.? J Urol. 2001;166(5):1862-4. PMID: 11586249Gofrit ON, Pode D, Meretyk S, Katz G, Shapiro A, Golijanin D, Wiener DP, Shenfeld OZ, Landau EH. Is the pediatric ureter as efficient as the adult ureter in transporting fragments following extracorporeal shock wave lithotripsy for renal calculi larger than 10 mm.? J Urol. 2001;166(5):1862-4. PMID: 11586249Resorlu B, Unsal A, Tepeler A, Atis G, Tokatli Z, Oztuna D, Armagan A, Gurbuz C, Caskurlu T, Saglam R. Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in children with moderate-size kidney stones: results of multi-institutional analysis. Urology. 2012;80(3):519-23. https://doi.org/10.1016/j.urology.2012.04.018Resorlu B, Unsal A, Tepeler A, Atis G, Tokatli Z, Oztuna D, Armagan A, Gurbuz C, Caskurlu T, Saglam R. Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in children with moderate-size kidney stones: results of multi-institutional analysis. Urology. 2012;80(3):519-23. https://doi.org/10.1016/j.urology.2012.04.018Mugiya S, Ozono S, Nagata M, Takayama T, Nagae H. Retrograde endoscopic management of ureteral stones more than 2 cm in size. Urology. 2006;67(6):1164-8; discussion 1168. https://doi.org/10.1016/j.urology.2006.01.088Mugiya S, Ozono S, Nagata M, Takayama T, Nagae H. Retrograde endoscopic management of ureteral stones more than 2 cm in size. Urology. 2006;67(6):1164-8; discussion 1168. https://doi.org/10.1016/j.urology.2006.01.088Kumar V, Ahlawat R, Banjeree GK, Bhaduria RP, Elhence A, Bhandari M. Percutaneous ureterolitholapaxy: the best bet to clear large bulk impacted upper ureteral calculi. Arch Esp Urol. 1996;49(1):86-91. PMID: 8678608Kumar V, Ahlawat R, Banjeree GK, Bhaduria RP, Elhence A, Bhandari M. Percutaneous ureterolitholapaxy: the best bet to clear large bulk impacted upper ureteral calculi. Arch Esp Urol. 1996;49(1):86-91. PMID: 8678608Maheshwari PN, Oswal AT, Andankar M, Nanjappa KM, Bansal M. Is antegrade ureteroscopy better than retrograde ureteroscopy for impacted large upper ureteral calculi? J Endourol. 1999;13(6):441-4. https://doi.org/10.1089/end.1999.13.441Maheshwari PN, Oswal AT, Andankar M, Nanjappa KM, Bansal M. Is antegrade ureteroscopy better than retrograde ureteroscopy for impacted large upper ureteral calculi? J Endourol. 1999;13(6):441-4. https://doi.org/10.1089/end.1999.13.441Goel R, Aron M, Kesarwani PK, Dogra PN, Hemal AK, Gupta NP. Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries. J Endourol. 2005;19(1):54-7. https://doi.org/10.1089/end.2005.19.54Goel R, Aron M, Kesarwani PK, Dogra PN, Hemal AK, Gupta NP. Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries. J Endourol. 2005;19(1):54-7. https://doi.org/10.1089/end.2005.19.54Mak D, Wragg R, Chandran H, McCarthy R, Parashar K. Silent But Giant: Giant ureteric calculus in a 7-year-old boy. J Surg Case Rep. 2010;2010(5):8. https://doi.org/10.1093/jscr/2010.5.8Mak D, Wragg R, Chandran H, McCarthy R, Parashar K. Silent But Giant: Giant ureteric calculus in a 7-year-old boy. J Surg Case Rep. 2010;2010(5):8. https://doi.org/10.1093/jscr/2010.5.8Dincel N, Resorlu B, Unsal A, Tepeler A, Silay MS, Armağan A, Diri A, Sancaktutar AA, Ziypak T, Mir S. Are small residual stone fragments really insignificant in children? J Pediatr Surg. 2013;48(4):840-4. https://doi.org/10.1016/j.jpedsurg.2012.07.061Dincel N, Resorlu B, Unsal A, Tepeler A, Silay MS, Armağan A, Diri A, Sancaktutar AA, Ziypak T, Mir S. Are small residual stone fragments really insignificant in children? J Pediatr Surg. 2013;48(4):840-4. https://doi.org/10.1016/j.jpedsurg.2012.07.061El-Assmy A, El-Nahas AR, Harraz AM, El Demerdash Y, Elsaadany MM, El-Halwagy S, Sheir KZ. Clinically Insignificant Residual Fragments: Is It an Appropriate Term in Children? Urology. 2015;86(3):593-8. https://doi.org/10.1016/j.urology.2015.06.017El-Assmy A, El-Nahas AR, Harraz AM, El Demerdash Y, Elsaadany MM, El-Halwagy S, Sheir KZ. Clinically Insignificant Residual Fragments: Is It an Appropriate Term in Children? Urology. 2015;86(3):593-8. https://doi.org/10.1016/j.urology.2015.06.017

The authors declare that there are no conflicts of interest present.