Technical refinements for ureterorenoscopy in the management of ureteric calculi in children

PURPOSE

To report our evolving experience with ureterorenoscopy in the treatment of pediatric ureteric stones.

MATERIAL AND METHODS

Between 1997-2006, 60 ureteroscopic interventions were performed in 54 children (28 male, 26 female) aged 12 months to 14 years (mean 5.3 years). We used rigid ureterorenoscopes (7.5/8/10 F) for all and Ho:YAG laser in 51, pneumatic lithotripsy in 3 and forceps extractor in 4. Two of 4 proximal ureteric stones were pushed back and treated with ESWL, and 2 were grasped with the Nitinol basket at the renal pelvis and fragmented using Ho:YAG energy. The mean stone size was 7.8 mm (4-20 mm) and follow up was between 1 to 38 months (mean 14 months).

RESULTS

The overall stone free rate after a single session of ureterorenoscopy was 88%. All but one patient were stone free following an auxiliary procedure with a final success rate of 98%. Ureteric perforation was noted in 4 patients and 2 were treated conservatively while two required open surgery. A JJ stent or ureteric catheter was left in place routinely; we still like to use stenting even in uncomplicated procedures. Routine dilatation using balloons or dilators for the distal 4 cm up to 10 F has evolved and water dilatation using the Perez-Castro irrigation pump in last 2 years.Use of Nitinol baskets replaced the grasping forceps. The average operative time is markedly shortened.

CONCLUSIONS

Ureteroscopy and lithotripsy using Ho:YAG laser is an effective and safe method for the treatment of ureteric stones in children. With increasing experience more proximal and bigger size stones can easily be treated with less complications . In our practice URS is the first line treatment for almost all ureteric stones.

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