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Ureteroscopy for the treatment of urolithiasis in children
Timothy G Schuster1, Kelly Y Russell, David A Bloom
1Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.
Insights
Ureteroscopy is a safe and effective treatment for kidney stones in children. This study found that routine ureteral dilation and stenting are not always necessary for successful outcomes in pediatric urolithiasis cases.
Area of Science:
- Pediatric Urology
- Endourology
- Urolithiasis Management
Background:
- Ureteroscopy for pediatric urolithiasis is increasingly common due to smaller instruments.
- This study reviews institutional experience and literature on ureteroscopy in prepubertal children.
Purpose of the Study:
- To evaluate the safety and efficacy of ureteroscopy for treating urolithiasis in prepubertal children.
- To assess the necessity of routine ureteral dilation and stenting in this patient group.
Main Methods:
- Retrospective review of 27 ureteroscopic stone extractions in 25 prepubertal children (1994-2000).
- Procedures were performed similarly to adult ureteroscopy, with dilation and stenting as needed.
- Complications and stone-free rates were recorded.
Main Results:
- The study included 25 children (13 male, 12 female) aged 3-14 years with stones 2-12 mm.
- Ureteral dilation was performed in 56% and stenting in 70% of procedures.
- 92% of children were stone-free after one procedure, and 100% after two, with minimal complications.
Conclusions:
- Ureteroscopy is a safe and effective treatment for urolithiasis in prepubertal children.
- Routine ureteral dilation and ureteral stent placement are not consistently required for successful outcomes.
Purpose:
Ureteroscopy for treating urolithiasis in prepubertal children has become more common with the advent of smaller instruments. We reviewed our experience with ureteroscopy for urolithiasis in this cohort of patients as well as the literature using this treatment modality in children.
Materials And Methods:
Between 1994 and 2000 we performed 27 ureteroscopic stone extractions in 25 children. Ureteroscopy was done in a manner similar to that in adults. Ureteral dilation was performed when necessary to access the ureter. A stent was placed postoperatively if there was significant ureteral trauma.
Results:
Of the 25 children 13 were male and 12 were female. Average age was 9.2 years (range 3 to 14). Stones were 2 to 12 mm. in greatest diameter (average 6). Of the 27 procedures the ureteral orifice was dilated before stone treatment in 15 (56%), while in 19 (70%) a stent was placed afterward. No intraoperative and 2 postoperative complications were identified. Overall 92% of the children were rendered stone-free after 1 procedure and 100% were stone-free after 2.
Conclusions:
Ureteroscopy for urolithiasis in prepubertal children is safe and effective. Routine ureteral dilation and ureteral stent placement are not always necessary in these patients.