Minimally invasive treatment of ureteral calculi in children

Abstract

A retrospective analysis was done to determine the efficacy of shock wave lithotripsy (SWL) and ureteroscopy in the treatment of paediatric ureteral calculi. We reviewed the records of 67 (35 boys, 32 girls) children (71 ureters) admitted to our clinic for treatment of ureteral calculi during 1990-2005. The initial treatment method was SWL in 80.3% (57 ureters), ureteroscopy in 11.3% (eight ureters) and open surgery in 8.5% (six ureters) of the renal units. The mean age of the patients was 10.67 +/- 4.4(1-16) years. The stone-free rates after SWL for upper, middle and lower ureteral calculi were 74.1, 100 and 75.9%, respectively. Increased stone diameter (P = 0.014) and/or burden (P = 0.002) were found to be significant factors that had an adverse affect on the stone-free rate after SWL while the success rates of SWL were independent of location. Including six patients (seven ureters) with failed SWL, a total of 14 patients (15 renal units) subjected to ureteroscopy for lower ureteral calculi yielded a stone-free rate of 93.3%. Thus, the overall stone-free rates after SWL, ureteroscopy and open surgery were found to be 75.4, 93.3 and 100%, respectively. Depending on the stone burden, SWL might be a good option for initial treatment of most ureteral calculi in children. Ureteroscopy offers a high success rate for lower ureteral calculi, including SWL failures.

Semi-rigid ureterorenoscopy in children without ureteral dilatation

“…In our work, following our diagnostic and therapeutic URS applications, have routinely applied a ureteral catheter in order to prevent renal colic as a result of small stone fragments and edema. This ureteral catheter is removed after 24 h. While the success rates of ureteral stone treatment by ureteroscopy vary between 86 and 94% in the relevant literature, this rate increases to 100% with secondary interventions [1][2][3][4][5][6][7][8][9][10][11][12]. Our success rate of 95.2% paralleled those reported in the literature.…”

“…In a study conducted by Borgmann et al in 1982, ureteral calculi were reported to constitute 7% of all stones occurring in children [9]. Today, the incidence of urinary system stone disease in children is known to increase continuously [3]. As a result of the complementary devices (electrohydraulic litothripsi (EHLT), pneumatic lithotriptor, basket catheters, forceps, etc.)…”

“…The pediatric literature includes the employment of URS in pathologies such as renal hemangioma, arteriovenous malformations, ureteropelvic stenosis, ureteral stricture, and ureteral polyp [8]. However, its most common indication in children is to treat urolithiasis [3]. Formerly, urinary system calculi were known to occur rarely in children.…”

“…Other minimally invasive methods have been scarcely applied due to technical limitations in children [2]. Today, because of the production of ureterorenoscopes with high technology and the advanced video technologies of optical systems, ureteroscopy is commonly used by pediatric urologists as well as their counterparts [3]. In the present study, we aimed to retrospectively review the safety and efficacy of URS applied without ureteral dilatation for evaluating pediatric ureteral pathologies.…”

Contemporary minimal invasive surgical management of stones in children

“…Therefore, previous worries about the potential for injury to the ureteral mucosa, ureteral meatus, and urethra, especially in male youngsters, when using comparatively larger diameter instruments (11.5 Fr and 8.5 Fr), are no longer warranted. Instrument-related problems are now extremely rare due to the availability and effective usage of 4.5 Fr and 6.0 Fr semirigid ureteroscopes and 6.9 Fr flexible ureterorenoscope with a holmium:YAG laser energy source [ [34] , [35] , [36] , [37] ].…”