Paediatric ureteroscopy for ureteric calculi: a 4-year experience
S S al Busaidy1, A R Prem, M Medhat
1Department of Urology, Armed Forces Hospital, Muscat, Sultanate of Oman.
Insights
Ureteroscopy is a safe and effective treatment for pediatric ureteral stones, particularly in the lower and mid ureter. While slightly less effective for upper ureteral calculi, it offers a high stone-free rate with minimal complications.
Area of Science:
- Pediatric Urology
- Endourology
- Nephrolithiasis Management
Background:
- Ureteral calculi in children pose a management challenge.
- Minimally invasive techniques are preferred for pediatric stone removal.
Purpose of the Study:
- To evaluate the efficacy and safety of ureteroscopy for treating pediatric ureteral stones.
- To assess outcomes based on stone location within the ureter.
Main Methods:
- Retrospective analysis of 50 ureteroscopies in 43 children (6 months-12 years).
- Stones located in upper, mid, and lower ureters.
- Electrohydraulic lithotripsy (EHL) used for fragmentation.
- Follow-up included intravenous urograms and micturating cystography (MCUG).
Main Results:
- An overall stone-free rate of 93% was achieved.
- Success rates were 78% (upper), 100% (mid), and 97% (lower ureter).
- Minor complications included two ureteric perforations and transient, clinically insignificant vesico-ureteric reflux.
Conclusions:
- Ureteroscopy is safe and effective for mid and lower ureteral calculi in children.
- Outcomes for upper ureteral calculi were marginally inferior.
- Judicious use of ureteroscopy minimizes ureteric injury and vesico-ureteric reflux.
Objective:
To study the efficacy and safety of ureteroscopy in the management of paediatric ureteric calculi at various levels.
Patients And Methods:
The records of 50 ureteroscopic procedures performed on 43 children (age range 6 months-12 years) for primary ureteric calculi or ureteric fragments after electrohydraulic shockwave lithotripsy (EHWL) were analysed retrospectively. The distribution of the calculi was in nine in the upper upper, seven in the mid and 30 in the lower ureter, with a mean stone burden of 1.26 cm. Ureteroscopy was performed with the 8.5/9.5/11.5 F Wolf ureteroscopes, and EHL was used as the primary method of fragmentation. Intravenous urograms were available in 34 children (79%) and micturating cystography (MCUG) was performed in 23 children (54%) during the follow-up.
Results:
An overall stone-free status was achieved in 40 children (93%) after performing 47 ureteroscopies (94%). Stones were completely cleared in 78%, 100% and 97% of the procedures in the upper, mid and lower ureters, respectively. In three children the procedure failed and they were salvaged by uretero-lithotomy. During the procedures, an upper ureteric perforation occurred in one patient and a lower perforation in another. MCUG revealed low grade vesico-ureteric reflux in 17% of the patients, but close follow-up showed the reflux to be sterile and clinically insignificant.
Conclusion:
Ureteroscopy was safe and effective for the management of mid and lower ureteric calculi but the results for upper ureteric calculi were marginally inferior. Ureteroscopy must be performed judiciously to minimize ureteric injury in children. The incidence of vesico-ureteric reflux after mechanical dilatation of the intramural ureter was infrequent and clinically insignificant.
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