Summary
Introduction
Ureteroscopy has been shown to be a highly efficacious and safe modality for the treatment
of pediatric urolithiasis. However, conventional ureteroscopy relies on fluoroscopy
for intraoperative guidance, exposing both patient and operating room personnel to
ionizing radiation. Pediatric urolithiasis patients are at a particularly increased
risk from this radiation exposure. The use of ultrasound in place of fluoroscopy for
intraoperative guidance has emerged as one modification that can reduce radiation
exposure during ureteroscopy. Although ultrasound-guided ureteroscopy has been shown
to be a safe, and effective approach to stone management in adults, there have been
no studies to date utilizing this approach in children.
Objective
The aim was to describe our initial experience with ultrasound-guided ureteroscopy
in children as a safe and feasible modality to manage pediatric urolithiasis.
Study design
A retrospective review of consecutive patients that underwent ultrasound-guided ureteroscopy
by one pediatric urologist (A.K.S.) from 2014 to 2016 for symptomatic urolithiasis
was performed. Patient data were extracted from our center's IRB-approved prospectively
maintained database of all children with urolithiasis.
Materials and methods
Real-time ultrasonic guidance was provided by a pediatric uroradiology attending,
with fluoroscopy available on standby. With the probe positioned on the patient's
flank, ultrasound was used to visualize advancement of guidewire, dual-lumen catheter,
and ureteroscope through the ureteral orifice and up to the renal pelvis (Figure).
Stones were identified and removed via basket retrieval. At the conclusion of each
case, ultrasonography was then used to confirm stent placement of indwelling double
pigtail ureteral catheters.
Results
Eleven patients were identified that underwent 12 ultrasound-guided ureteroscopic
procedures in an outpatient setting. Stones were accessed in various locations and
were removed by basket retrieval. Laser calycostomy into calyceal diverticulum and
balloon dilations of ureterovesical junction and calyceal infundibulum were also performed.
There were Clavien grade I and II complications in four patients; all of which were
related to pain control.
Discussion
To our knowledge, this is the first study reporting the successful use of ultrasound-guided
ureteroscopy in children. The main limitation of this feasibility study is its small
sample size. A larger series is needed to corroborate these findings and make them
generalizable to a wider population.
Conclusion
Graphical AbstractIntraoperative ultrasound showing guidewire (solid arrow) and ureteroscope (dotted
arrow).
Keywords
Abbreviations:
ESWL (extracorporeal shock wave lithotripsy), BMI (body mass index), mGy (milligray), ALARA (as low as reasonably achievable)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 13, 2017
Accepted:
August 21,
2017
Received:
April 20,
2017
Identification
Copyright
© 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
