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Ureteroscopy and Laser Lithotripsy for Large (≥2 cm) Upper Tract Urinary Stones in Pediatric Patients: Outcomes from
Victoria Jahrreiss1, Stephen Griffin2, Bhaskar Somani2
1Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Insights
Ureteroscopy and laser stone fragmentation (URSL) is a safe and effective treatment for large pediatric upper tract urinary stones. This procedure shows a high stone-free rate and minimal complications in children.
Area of Science:
- Pediatric Urology
- Endourology
- Nephrolithiasis Management
Background:
- Pediatric urolithiasis prevalence is rising, presenting challenges in managing large urinary stones.
- Ureteroscopy and laser stone fragmentation (URSL) is explored as a treatment for large upper tract stones in children.
Purpose of the Study:
- To evaluate the safety and efficacy of URSL for pediatric patients with large upper urinary tract stones (≥2 cm).
Main Methods:
- Retrospective analysis of a prospective database of 23 pediatric patients (median age 11 years) treated with URSL between 2011-2023.
- Analysis included stone characteristics, operative details, stone-free rates (SFR), and complications.
Main Results:
- High stone-free rate (SFR) of 91.3% after the first procedure.
- Mean stone length was 24.7 mm; 52.2% had multiple stones.
- Low complication rate, with only one case of postoperative fever (Clavien-Dindo I).
Conclusions:
- URSL is a safe and efficient option for pediatric large upper tract stones, offering an alternative to percutaneous surgery.
- High SFR and low complication rates support URSL, with appropriate parental counseling recommended.
Abstract:
The global prevalence of pediatric urolithiasis is increasing. Managing large urinary stones in pediatric populations poses a particular clinical challenge. This study evaluates the safety and efficacy of ureteroscopy and laser stone fragmentation (URSL) for treating large upper urinary tract stones in pediatric patients. A retrospective analysis of the prospective database was conducted on pediatric patients who underwent URSL for stones ≥2 cm between 2011 and 2023 (14 years) at the University Hospital Southampton, UK. Patient demographics, stone characteristics, operative details, stone-free rates (SFR), and complications were analyzed. In total, 23 patients (median age 11 years) underwent URSL. The mean total stone length was 24.7 ± 6.49 mm, with 12 (52.2%) having multiple stones. Prestenting, ureteral access sheath, and postop stenting were used in 9 (39.1%), 4 (17.4%), and 10 patients (43.5%), respectively. Holmium laser was used, and the SFR after the first procedure was 91.3%, with no procedural complications. There was only one complication (postoperative fever, Clavien-Dindo I) reported. The median length of stay was 1 day. URSL is safe and efficient for treating large upper tract urinary stones in pediatric patients, demonstrating high SFR and low complication rate. This could offer an alternative treatment modality to percutaneous surgery in large upper urinary tract stones, although parents need to be adequately counseled about it.
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