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OBJECTIVETo compare the efficacy and safety of ureteroscopy plus intracorporeal lithotripsy (ULT) with extracorporeal shock wave lithotripsy (ESWL) for treating distal ureteric calculi in childhood, as such stones are commonly treated by ESWL as the first option in adults but there is no agreement on the method of treating them in children. PATIENTS AND METHODSFrom July 2002 to July 2003, children presenting with ureteric stones were consecutively randomized for treatment using ULT or ESWL. The two groups were matched for age, sex and stone position in the distal ureter. A 7.5 F ureteroscope combined with a ballistic lithotripter or holmium-YAG laser was used for ULT. ESWL was administered using a second-generation lithotripter. The success rate, effectiveness quotient, complication rate and hospitalization were evaluated and compared using Student's t-test (chi-square) and Fisher's exact test as appropriate. In all, 31 patients (21 girls and 10 boys, mean age 7.2 years, range 2-17) were treated, by ULT in 17 (12 girls and five boys) and ESWL as a primary procedure in 14 (five boys and nine girls). RESULTSAfter one ULT, all the girls and four boys, and after ESWL, four girls and two boys, were rendered stone-free at the first treatment. The total stone-free rate was 16 of 17 for ULT and six of 14 for ESWL ( P = 0.004). Eight patients had a second ESWL and three then became stone-free. The five patients in whom both ESWL treatments failed had a successful ULT. There was no significant difference between the groups in complication rate and hospitalization. General anaesthesia was required in all patients < 12 years old treated by ULT or ESWL. The calculated efficiency quotient for treating distal ureteric calculi was significantly lower for ESWL than ULT ( P < 0.05). CONCLUSIONSULT should be recommended as the treatment of choice for distal ureteric calculi in children; using small ureteroscopes the target stone was treated safely and effectively.

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OBJECTIVE To assess the characteristics of cystitis glandularis in children. PATIENTS AND METHODS Three cases of cystitis glandularis in children are described, occurring in boys aged 9–13 years. The presenting symptoms were gross haematuria in the first patient and frequency and urgency in the second. The third patient was asymptomatic and the lesion appeared as a wide thickening of the bladder wall on follow‐up ultrasonography for previous surgery. In all patients, a polypoid bladder mass was found at cystoscopy and diagnosed at histology. The endoscopic resection, with long‐term antibiotic prophylaxis, was the treatment of choice, with no recurrence at 12–30 months of follow‐up. CONCLUSION Cystitis glandularis has been rarely described in children, and is probably related to chronic or recurrent infections or an inflammatory reaction. Its potential premalignant significance is still the subject of debate.

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