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Ureteroscopy for stone disease in the paediatric population: a systematic review
Hiro Ishii1, Stephen Griffin2, Bhaskar K Somani1
1Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
Insights
Ureteroscopy (URS) is a safe treatment for pediatric kidney stones, achieving an 87.5% stone-free rate. However, younger children under 6 experience higher complication and failure rates during URS procedures.
Area of Science:
- Urology
- Pediatric Surgery
Background:
- Pediatric stone disease presents unique challenges in management.
- Ureteroscopy (URS) has emerged as a key minimally invasive treatment option.
Purpose of the Study:
- To systematically review the efficacy and safety of ureteroscopy (URS) for treating pediatric urolithiasis.
- To evaluate the impact of patient age on URS outcomes.
Main Methods:
- Systematic review of English-language studies published between January 1990 and May 2013.
- Inclusion criteria: minimum 50 pediatric patients (≤18 years) treated with URS for stone disease.
- Data extraction by two independent reviewers, focusing on stone-free rates, complications, and failure rates.
Main Results:
- 14 studies comprising 1718 procedures were analyzed.
- Overall stone-free rate (SFR) was 87.5%; most stones were ureteral (83.4%).
- Children under 6 years showed higher failure (4.4% vs 1.7%) and complication (24.0% vs 7.1%) rates compared to older children.
Conclusions:
- Ureteroscopy is a relatively safe and effective treatment for pediatric stone disease with a good SFR.
- Younger children (<6 years) undergoing URS face increased risks of procedural failure and complications.
Abstract:
The aim of the present review was to look at the role of ureteroscopy (URS) for treatment of paediatric stone disease. We conducted a systematic review using studies identified by a literature search between January 1990 and May 2013. All English-language articles reporting on a minimum of 50 patients aged ≤ 18 years treated with URS for stone disease were included. Two reviewers independently extracted the data from each study. A total of 14 studies (1718 procedures) were reported in patients with a mean (range) age of 7.8 (0.25-18.0) years. The mean (range) stone burden was 9.8 (1-30) mm and the mean (range) stone-free rate (SFR) 87.5 (58-100)% with initial therapeutic URS. The majority of these stones were in the ureter (n = 1427, 83.4%). There were 180 (10.5%) Clavien I-III complications and 38 cases (2.2%) where there was a failure to complete the initial ureteroscopic procedure and an alternative procedure was performed. To assess the impact of age on failure rate and complications, studies were subcategorized into those that included children with either a mean age <6 years (four studies, 341 procedures) or a mean age >6 years. (10 studies, 1377 procedures). A higher failure rate (4.4 vs 1.7%) and a higher complication rate (24.0 vs 7.1%) were observed in children whose mean age was <6 years. URS for paediatric stone disease is a relatively safe procedure with a reasonably good SFR, but there seems to be a higher failure and complication rate in children aged <6 years.
