Introduction: Fibroepithelial polyps of the ureter are rare. Cases and small series are reported in the literature. The treatment of choice, outcome and appropriate follow-up regimen remain unclear. Methods: We conducted a systematic literature review of papers reporting fibroepithelial polyps of the ureter in adult patients. Articles published before 1980 were excluded. Results: The search yielded 144 papers, of which 68 met the inclusion criteria. A reference scan from the included 68 yielded an additional 7 new articles. In total, our study included 75 articles (68 + 7). A total of 134 patients were described. Most patients had a single lesion (range: 1-10). The median length of the polyp was 4.0 cm (range: 0.4-17.0). The percentage of polyps resected endoscopically increased from 0% before 1985 to 67% after 2005. Two perioperative complications were reported in 72 procedures (2.8%): a deep venous thrombosis and a case of mesenteric lymphadenopathy. Both of these occurred after open surgery. Follow-up data were available for 57 patients. The median follow-up was 12 months (range: 1-180). Four patients (7.0%) developed recurrent complaints: 2 had urinary stones, 1 had a ureteral stricture and 1 had recurrence of the polyp. Three of these events followed endoscopic resection, and occurred within a year after the procedure. Conclusion: Endoscopic resection of fibroepithelial polyps seems to be safe and effective. It is minimally invasive and should be considered the gold standard where endoscopic expertise is available. We advise follow-up imaging by computed tomographic intravenous urography after 3 months and ultrasound after 1 year to detect late complications.
The stone-free rate after URS is much higher than after SWL, and the EQ in our series was strongly dependent on definitions. The decision about how to treat a patient with an extended-mid or distal ureteral stone therefore should not be made primarily on the basis of cost effectiveness but rather on the basis of the availability of proper equipment, the experience of the urologist, and the preference of the patient.
What's known on the subject? and What does the study add?• Without age being a limiting risk factor, recent reports have shown that almost any version of percutaneous nephrolithotomy (PCNL) can be safely applied in children. As there has been no standardisation in the age categorisation of children, there are inconsistencies among the age subgroups in the current literature.• To achieve a standard terminology and thus a common language, the World Health Organization age classification criterion was used in the present study. Based on the findings, we can suggest that PCNL can be applied safely and effectively in children in different age groups.
Objectives• To present the overall results of paediatric percutaneous nephrolithotomy (PCNL) compared with adults.• To present the indications, complications and outcomes of patients treated in the participating centres in the PCNL Global Study, as categorised in different age groups.
Patients and Methods• The Clinical Research Office of the Endourological Society (CROES) Study was conducted from November 2007 to December 2009, and included 96 centres and >5800 patients.• All children aged Յ14 years in the PCNL Global Study database were the focus of the study.
Results• In all, 107 children aged Յ14 years were included in the analysis.• The PCNL procedure was conducted in 13 patients (12.1%) in the supine position; tubeless PCNL was performed in 15 patients (14%); and balloon dilatation was preferred in 22 patients (20.5%). The overall mean operative duration was 97.02 min; blood transfusion rate, fever and stone-free rates were 9%, 14% and 70.1%, respectively. • A comparison of the paediatric PCNL cases according to age groups showed no statistically significant differences between the subgroups for patient characteristics, co-morbidities, renal anomalies, or previous surgical history. • In the evaluation of the operative details, the mean sheath size and nephrostomy tube size were larger in school-age children than the preschool children (P = 0.01 and 0.002, respectively). There was a difference in the preferred methods for confirming stone-free status, with ultrasonography preferred more in preschool children (P < 0.001).• The PCNL procedure position, puncture site, dilatation method, postoperative tube application, and surgical outcomes were comparable in school-and preschool-age children. While operative details showed some differences between children and adults, the surgical outcomes were comparable.
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