Ureteroscopy for pediatric urolithiasis: an evolving first-line therapy
A H H Tan1, M Al-Omar, J D Denstedt
1Division of Urology, Department of Surgery, University of Western Ontario, London, Ontario, Canada.
Insights
Ureteroscopy effectively treats pediatric kidney and ureteral stones in patients 14 years and younger. This minimally invasive procedure offers a high success rate for pediatric urolithiasis management.
Area of Science:
- Pediatric Urology
- Endourology
- Nephrolithiasis Management
Background:
- Pediatric urolithiasis (kidney and ureteral stones) treatment has evolved.
- Advancements in ureteroscopes and instruments make endoscopic stone removal feasible in children.
Purpose of the Study:
- To report on ureteroscopy outcomes for pediatric patients (≤14 years) with stones.
- Evaluate the safety and efficacy of ureteroscopy as a treatment for pediatric urolithiasis.
Main Methods:
- Retrospective chart review of 23 patients (≤14 years) treated for ureteral or renal calculi.
- Analysis of stone location, treatment modalities, operative time, and outcomes.
Main Results:
- 27 stones treated in 23 pediatric patients.
- High success rate: 95.2% stone-free after ureteroscopy.
- Holmium:YAG laser was the primary lithotripsy modality used.
Conclusions:
- Ureteroscopy is a safe and effective treatment for pediatric kidney and ureteral stones.
- It is a viable first-line therapy for pediatric urolithiasis at our institution.
Objectives:
To present in a retrospective report a contemporary series of patients aged 14 years and younger who were treated for stones with ureteroscopy at our institution from 1991 to 2002. With the improvement and miniaturization of ureteroscopes and ancillary instruments, the endoscopic treatment of renal and ureteral calculi in children has become more feasible.
Methods:
A retrospective chart review was performed of 23 patients aged 14 years and younger who had undergone ureteroscopy for the treatment of ureteral or renal calculi at our institution.
Results:
A total of 27 stones were treated in 23 patients. Of the 27 stones, 18 were in the distal ureter, 5 in the mid ureter, 2 in the proximal ureter, and 2 in the renal pelvis. Ureteral dilation was performed in 4 (17.4%) of the 23 patients. The lithotripsy modalities used were holmium:yttrium-aluminum-garnet laser in 16 (69.6%), electrohydraulic lithotripsy in 3 (13%), a combination of holmium laser and electrohydraulic lithotripsy in 2 (8.7%), and basket extraction alone in 2 (8.7%) of 23 patients. Ureteral stents were placed in 21 (91.3%) of 23 patients. The average operative time was 46.9 minutes (range 15 to 92). In 21 (91.3%) of 23 patients, postoperative imaging was available and revealed that 20 (95.2%) of the 21 patients were rendered stone free. Two patients were lost to follow-up. No intraoperative complications occurred. One patient was treated postoperatively with intravenous antibiotics for transient fever.
Conclusions:
Ureteroscopy is safe and effective in the management of ureteral and renal calculi in children. In our institution, it has emerged as a valid first-line therapy for the treatment of pediatric urolithiasis.
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