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Ureteroscopy and laser stone fragmentation (URSL) for large (≥1 cm) paediatric stones: Outcomes from a university
N C Featherstone1, B K Somani2, S J Griffin1
1Department of Paediatric Urology, University Hospital Southampton NHS Trust, Tremona Road, Southampton, UK.
Insights
Ureteroscopy and laser stone fragmentation (URSL) is an effective treatment for large pediatric kidney stones (≥1 cm), achieving an 89% stone-free rate with no complications. This minimally invasive approach offers a safe and viable option for managing complex pediatric urolithiasis.
Area of Science:
- Pediatric Urology
- Endourology
- Nephrolithiasis Management
Background:
- Treating large renal stones (≥1 cm) in children presents significant challenges.
- Traditional options like PCNL and SWL have limitations for pediatric patients.
- Ureteroscopy and laser stone fragmentation (URSL) is increasingly used, but outcomes for large stones in this age group require further investigation.
Purpose of the Study:
- To evaluate the effectiveness and outcomes of URSL for pediatric renal stones measuring ≥1 cm.
- To assess the stone-free rate, complications, and hospital stay associated with URSL in this cohort.
Main Methods:
- Retrospective review of a prospectively maintained stone database.
- Inclusion criteria: pediatric patients with stones ≥1 cm treated with rigid or flexible ureteroscopy (URS).
- Data collected: demographics, operative details, stone burden, hospital stay, complications, and stone clearance.
Main Results:
- 18 pediatric patients underwent 35 URSL procedures for stones ≥1 cm between April 2010 and June 2015.
- The overall stone-free rate (SFR) was 89% after a mean of 1.8 procedures per patient.
- No intra- or post-operative complications were observed, with a mean hospital stay of 1.1 days.
Conclusions:
- URSL demonstrates excellent outcomes for managing large pediatric renal stones, comparable to adult studies.
- The procedure achieves a high stone-free rate with minimal morbidity.
- URSL is a safe and effective treatment option for large pediatric stones in experienced endourological centers.
Introduction:
The treatment of large renal stones (≥1 cm) in paediatric patients is challenging. The usual treatment options include percutaneous nephrolithotomy (PCNL) or shockwave lithotripsy (SWL). There is a rise in the use of ureteroscopy and laser stone fragmentation (URSL) for paediatric stones; however, outcomes of treatment for large renal stones in this age group are still largely unknown.
Objective:
To investigate the outcome of URSL for large paediatric renal stones ≥1 cm treated at the present institution over the last 5 years.
Methods:
A retrospective review was performed of outcomes from the prospectively maintained stone database. Only paediatric patients undergoing ureteroscopic (rigid or flexible ureteroscopy (URS)) procedures for stones ≥1 cm were included. Patient demographics, operative details, stone burden, hospital stay, complications and stone clearance were recorded and analysed.
Results:
From April 2010 to June 2015, 18 paediatric patients with a mean age of 10.4 years (range 3.6-15) underwent 35 ureteroscopic procedures for large stones (≥1 cm). The stone location was in the kidney (n = 14), ureter (n = 1), and in both the kidney and ureter for the remaining three patients. Nine patients had multiple stones. There was a preceding history of PCNL in four patients, with one patient having URS combined with a PCNL. The mean follow-up was 2.7 years (range 0-5). A postoperative stent was inserted in 21 (60%) patients. The overall stone-free rate (SFR) was 89% for a mean of 1.8 procedures per patient (range 1-4) - see Summary Table below. There was an inability to access stone within a lower pole calyx in one patient, despite maximum deflection of the ureteroscope. No intra- or post-operative complications were noted, and mean hospital stay was 1.1 days (range 0-5).
Discussion:
Published papers in adult literature have shown that ureteroscopy and laser fragmentation (URSL) is a viable alternative to PCNL. Newer equipment and improved techniques have resulted in SFRs being comparable with PCNL. A recent systematic review reported an SFR of 91% for large adult stones (>2 cm) for a mean 1.45 procedures per patient, and an overall complication rate of 8.6%. The present study has also demonstrated excellent outcomes in the use of ureteroscopy and laser fragmentation for the management of large paediatric stones with no complications.
Conclusion:
The results show that paediatric URSL for large stones achieves a good SFR with minimal morbidity and is a good treatment option in established endourological units.
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