Pediatric ureteroscopic management of intrarenal calculi
Stacy T Tanaka1, John H Makari, John C Pope
1Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee 37232-9820, USA. stacy.tanaka@vanderbilt.edu
Insights
Ureteroscopy is a safe treatment for kidney stones in children. However, success rates are lower for intrarenal stones, and younger children or those with larger stones may need more procedures.
Area of Science:
- Pediatric Urology
- Endourology
- Nephrolithiasis Management
Background:
- Limited data exists on ureteroscopic management of intrarenal calculi in prepubertal children.
- This study addresses the gap by reviewing institutional experience.
Purpose of the Study:
- To evaluate the efficacy and outcomes of ureteroscopic treatment for intrarenal stones in children under 14 years old.
- To identify factors influencing stone-free status and the need for repeat procedures.
Main Methods:
- Retrospective review of 50 children (52 kidneys) undergoing ureteroscopy for intrarenal calculi.
- Analysis of stone-free rates and factors associated with treatment success using logistic regression.
Main Results:
- The initial stone-free rate was 50%, increasing to 58% with extended follow-up.
- Stone size was a significant predictor of initial stone-free status (p=0.005).
- Younger age (p=0.04) and larger stone size (p=0.002) correlated with the need for additional procedures, particularly for stones ≥6 mm.
Conclusions:
- Ureteroscopy is a safe and viable option for intrarenal calculi in prepubertal children.
- The stone-free rate for intrarenal stones is lower compared to ureteral stones.
- Counseling parents on the likelihood of repeat procedures, especially for larger stones or younger children, is crucial.
Purpose:
Data addressing ureteroscopic management of intrarenal calculi in prepubertal children are limited. We reviewed our experience from January 2002 through December 2007.
Materials And Methods:
We retrospectively reviewed ureteroscopic procedures for intrarenal calculi in children younger than 14 years. Stone-free status was determined with postoperative imaging. Multiple logistic regression analysis was used to assess the influence of preoperative factors on initial stone-free status and the need for additional procedures.
Results:
Intrarenal calculi were managed ureteroscopically in 52 kidneys in 50 children with a mean age of 7.9 years (range 1.2 to 13.6). Mean stone size was 8 mm (range 1 to 16). Stone-free rate after a single ureteroscopic procedure was 50% (25 of 50 patients) on initial postoperative imaging and 58% (29 of 50) with extended followup. Initial stone-free status was dependent on preoperative stone size (p = 0.005) but not stone location. Additional stone procedures were required in 18 upper tracts. Younger patient age (p = 0.04) and larger preoperative stone size (p = 0.002) were associated with the need for additional procedures. Additional procedures were required in more than half of the stones 6 mm or larger but in no stone smaller than 6 mm.
Conclusions:
Ureteroscopy is a safe method for the treatment of intrarenal calculi in the prepubertal population. Our ureteroscopic stone-free rate for intrarenal stones is lower than that reported for ureteral stones. Parents should be informed that additional procedures will likely be required, especially in younger patients and those with stones larger than 6 mm.
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