Therapeutic ureteroscopy for urolithiasis in children younger than 60 months of age
Rajendra B Nerli1, Manas Sharma2, Pulkit Gupta2
1Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), JNMC Campus, Nehru Nagar, Belagavi, 590010, Karnataka, India. rbnerli@gmail.com.
Insights
Therapeutic ureterorenoscopy (URS) is a safe and effective treatment for urinary stones in young children. This minimally invasive procedure offers a high stone clearance rate, making it a recommended first-line therapy.
Area of Science:
- Pediatric Urology
- Endourology
- Pediatric Nephrology
Background:
- Urinary tract calculi management in children has advanced with improved endoscopic technology.
- Smaller caliber endoscopes and Holmium:YAG laser have expanded indications for therapeutic ureteroscopy (URS).
Purpose of the Study:
- To review the experience and outcomes of therapeutic ureterorenoscopy (URS) in children under 60 months of age.
- To evaluate the safety and efficacy of URS for urolithiasis in very young children.
Main Methods:
- Retrospective review of inpatient and outpatient records and imaging data.
- Analysis of all children aged 60 months or younger undergoing URS for urinary stones.
Main Results:
- 77 children (70.1% male, mean age 28.97 months) underwent URS for single calculi.
- Stone clearance rate was 94.8% after single-stage URS; 5.2% required additional shockwave lithotripsy (SWL).
- Overall complication rate was 12.9%, including hematuria and fever.
Conclusions:
- Therapeutic ureterorenoscopy is safe and effective for ureteric and selective renal pelvic calculi in young children.
- URS can be considered a first-line therapy for pediatric urolithiasis in this age group.
Purpose:
The management of urinary tract calculi has evolved dramatically in children with the development of smaller and more durable endoscopic equipment. The indications for therapeutic ureteroscopy in children have significantly expanded with the availability of smaller caliber endoscopes and Holmium:YAG laser. In this paper, we review our experience of the management of urolithiasis and report outcomes of therapeutic ureterorenoscopy (URS) in children younger than 60 months.
Methods:
We retrospectively reviewed the inpatient, outpatient records, and imaging data of our hospital, of all children ≤ 60 months of age undergoing URS for the treatment of urinary stones.
Results:
During the study period; 77 children, mostly male (70.1%) presenting with a single calculus and a mean age of 28.97 ± 2.44 months underwent therapeutic URS. A majority of children (71.4%) had lower or mid-ureteric calculi. Pre URS double J (DJ) stenting was necessary for 21 (27.2%) children. A total of 24 (31.1%) children needed ureteric dilatation before the ureteroscopy. Post URS DJ stenting was necessary in 41 (53.2%) children. Stents were retrieved within 10 days of the procedure. Stone clearance rate following a single-stage URS procedure was 94.8%, and 4 (5.2%) children needed additional shockwave lithotripsy (SWL) to achieve stone clearance. Overall complication rate including hematuria and fever was 12.9% (10 patients).
Conclusion:
Therapeutic ureterorenoscopy in the management of ureteric and selective renal pelvic calculi is safe and effective. It can be considered as the first-line therapy in young children.
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