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Primary versus deferred ureteroscopy for the management of obstructive anuria secondary to ureteric urolithiasis in

Mostafa AbdelRazek1, Atef Fathi2, Mostafa Mohamed2

  • 1Department of Urology, Qena University Hospital, South Valley University, Qena, Egypt. mostafa_uro@yahoo.com.

Urolithiasis
|December 2, 2022
PubMed

Insights

Deferred ureteroscopy (URS) with prior stenting is more effective for pediatric obstructive anuria from ureteral stones. This approach leads to higher stone-free rates, shorter operative times, and fewer complications compared to primary URS.

Area of Science:

  • Pediatric Urology
  • Endourology
  • Nephrology

Background:

  • Obstructive anuria in children due to ureteral stones presents a significant clinical challenge.
  • Ureteroscopy (URS) is a common treatment, but the optimal timing (primary vs. deferred) requires investigation.

Purpose of the Study:

  • To compare the efficacy of primary URS versus deferred URS with ureteral stenting in pediatric patients with obstructive anuria secondary to ureteral urolithiasis.

Main Methods:

  • A prospective randomized study involving 120 pediatric patients (≤12 years) with obstructive anuria.
  • Patients were divided into two groups: primary URS (Group A) and deferred URS after ureteral stenting (Group B).
  • Outcomes assessed included operative time, renal function improvement, stone-free rate, and complication rates at 1-month follow-up.

Main Results:

  • Deferred URS (Group B) demonstrated a significantly higher stone-free rate (p≤0.001) and a significantly lower mean operative time (p≤0.001) compared to primary URS (Group A).
  • The overall complication rate was higher in the primary URS group.
  • Primary URS failed in 16.6% of patients, while stenting failure occurred in 11% of the deferred group.

Conclusions:

  • Deferred ureteroscopy with prior ureteral stenting is a preferable approach for managing obstructive anuria secondary to ureteral urolithiasis in children.
  • This strategy offers advantages including reduced need for ureteral dilatation, improved stone clearance, shorter procedures, and a lower complication profile.

Keywords:
AnuriaDeferred ureteroscopyUreteral stones

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