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Published on: January 7, 2019
When is prior ureteral stent placement necessary to access the upper urinary tract in prepubertal children?
Anthony T Corcoran1, Marc C Smaldone, Dev Mally
1Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213-3232, USA. corcoranat@upmc.edu
Insights
Patient characteristics like age, height, weight, and body mass index do not predict successful ureteroscopic access in children. Ureteroscopy without a prior ureteral stent is a viable option for pediatric upper tract stone treatment.
Area of Science:
- Pediatric Urology
- Endourology
Background:
- Ureteroscopic access to the upper urinary tract in children can be challenging.
- Predicting successful access without prior ureteral stent placement is important for procedural planning.
Purpose of the Study:
- To investigate if patient demographics (age, height, weight, BMI) predict successful ureteroscopic access in prepubertal children.
- To determine if initial ureteral stent placement is necessary for successful ureteroscopy in this population.
Main Methods:
- Retrospective review of ureteroscopic procedures for upper tract calculi in prepubertal children (2003-2007).
- Comparison of demographic data between patients with successful primary access and those requiring initial stent placement.
Main Results:
- Successful primary ureteroscopic access was achieved in 60% of patients.
- No statistically significant differences were found in age, height, weight, or body mass index between successful and unsuccessful access groups.
- Anatomical locations hindering access were varied and did not correlate with demographic factors.
Conclusions:
- Demographic factors (age, height, weight, BMI) are not predictive of successful ureteroscopic access in prepubertal children.
- Initial ureteral stent placement is not essential for successful access to the renal pelvis.
- Attempting ureteroscopy first, followed by stenting if needed, can reduce procedures and maintain low complication rates.
Purpose:
We studied the possibility that age, height, weight and body mass index could be used to predict the likelihood of successful ureteroscopic access to the upper urinary tract without previous stent placement in prepubertal children.
Materials And Methods:
We retrospectively reviewed all ureteroscopic procedures for upper tract calculi in prepubertal children from 2003 to 2007. We compared age, height, weight and body mass index in patients who underwent successful primary flexible ureteroscopic access and in those who required initial stent placement to perform ureteroscopy.
Results:
Successful primary ureteroscopic access to the upper tract was achieved in 18 of 30 patients (60%). There was no difference in mean age (9.9 vs 9.5 years, p = 0.8), height (132 vs 128 cm, p = 0.6), weight (37 vs 36 kg, p = 0.86) or body mass index (19.3 vs 20.5 kg/m(2), p = 0.55) between patients with successful vs unsuccessful upper tract access. Locations that prevented access to the upper urinary tract were evenly distributed among the ureteral orifice, iliac vessels and ureteropelvic junction.
Conclusions:
Age, height, weight and body mass index could not predict the likelihood of successful ureteroscopic access to the upper tract. Placement of a ureteral stent for passive ureteral dilation is not necessary for successful ureteroscopic access to the renal pelvis in prepubertal children. An initial attempt at ureteroscopy, with placement of a ureteral stent if upper tract access is unsuccessful, decreases the number of procedures while maintaining a low complication rate.
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