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Transureteral lithotripsy in pediatric practice
A Bassiri1, H Ahmadnia, M R Darabi
1Urology, Nephrology Research Center, Tehran, Iran. abbasbasiri@hotmail.com
Insights
Ureteroscopy effectively treats ureteral stones in children, achieving an 88% stone-free rate. This minimally invasive procedure, particularly with small-caliber ureteroscopes, is recommended as a first-line treatment for pediatric distal ureteral calculi.
Area of Science:
- Pediatric Urology
- Endourology
Background:
- Ureteral stones in children present unique management challenges.
- Minimally invasive surgical options are increasingly preferred for pediatric urolithiasis.
Purpose of the Study:
- To review the efficacy and outcomes of ureteroscopy for treating ureteral stones in pediatric patients.
- To evaluate the success rate and complications associated with ureteroscopic intervention in children.
Main Methods:
- A retrospective review of 66 ureteroscopies performed on pediatric patients (mean age 9 years) over six years.
- Procedures utilized semirigid ureteroscopes (8F-11.5F) under general anesthesia, with stone management including basketing and various lithotripsy methods.
- Pre-procedure imaging included ultrasonography, plain film, or intravenous urography; ureteral dilatation was employed as needed.
Main Results:
- An overall stone-free rate of 88% was achieved within 48 hours post-procedure.
- The complication rate was 23%, primarily consisting of gross hematuria and pyelonephritis; no ureteral perforations or strictures were noted at 3-month follow-up.
- Successful ureteroscope insertion was achieved in most cases, with stone management varying based on size and location, utilizing basketing or lithotripsy.
Conclusions:
- Ureteroscopy demonstrates a high success rate for treating ureteral calculi in pediatric patients.
- Small-caliber ureteroscopy is a highly effective and recommended first-line treatment for distal ureteral stones in children.
- The procedure offers a favorable safety profile with minimal long-term complications.
Purpose:
The present study reviews ureteroscopy intervention for the treatment of ureteral stones in pediatric patients in the last 6 years at three institutions in Iran.
Patients And Methods:
Sixty-six ureteroscopies were performed in 66 prepubertal patients (mean age 9 years; range 2-15 years) with a male/female ratio of 31/35. Ultrasonography, plain film, or intravenous urography was performed in all cases. The mean stone size was 8 mm (range 5-15 mm). All the interventions were performed under general anesthesia with semirigid ureteroscopes of 8F to 11.5F. The stone was located in the left ureter in 32 patients and in the right in 34 patients. Stones were located in the distal ureter in 59 patients, in the midureter in 5, and in the proximal ureter in 2. Before ureteroscopy, ureteral dilatation with a balloon was done to 12F if necessary. If the calculus could not be removed with the basket (stone.8 mm), lithotripsy using ultrasonic, electrohydraulic (EHL), or pneumatic equipment was performed.
Results:
Ureteroscopy with an 11.5F, 9F, 8.5F, or 8F ureteroscope were performed in 26, 14, 5, and 21 patients, respectively, and ureteral dilatation was necessary in 23, 0, 0, and 2 cases, respectively. We were unable to introduce the ureteroscope into the ureter in three patients (two boys with an 11.5F ureteroscope and one girl with an 8.5F ureteroscope) with distal ureteral stones. The stones moved to the kidney in four patients. Stone management was with basketing alone in 14, EHL in 3, ultrasonic lithotripsy in 8, and ballistic lithotripsy in 34 patients. The stone-free rate was 88% (58 patients) at 48 hours postprocedure. The complication rate was 23% and included renal colic (1), gross hematuria (11), and pyelonephritis (3). No patient had obvious perforation or stricture of the ureter at 3-month follow-up.
Conclusion:
Our series demonstrates the high success rate that can be achieved with ureteroscopic removal of ureteral calculi in children. Ureteroscopic treatment, especially with a small-caliber ureteroscope, should be considered the first choice for treatment of calculi in the distal ureter in children.