Retrograde ureteroscopy for distal ureteric stone removal in children

Abstract

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.

Ureteroscopic stone management in prepubertal children

“…Dominicis et al [6] compared the efficacy and safety of ureteroscopy with extracorporeal shock wave lithotripsy (ESWL) for treating distal ureteric calculi. In all 17 children underwent ureteroscopy and 14 children had ESWL.…”

“…The rationale for stent (1) Stone migration (2) Hematuria (1) Renal colic (1) Dominicis et al [6] 17 (17) placement has traditionally been to reduce the chances of stricture formation, postoperative pain, and acute pyelonephritis. However ureteral stents themselves are known to be responsible for significant pain and bladder spasms.…”

Laser or Pneumatic Lithotripsy in Pediatric Ureteral Stones: Which One is More Effective?

“…In SWL group, the stone free rate was 43% (6 of 14) after the first session, 64% (9 of 14) after the second session. The five patients of SWL group underwent successful ureteroscopy (11). These studies show that these two treatment modalities have almost the same clinical success with SWL group having more auxially measures.…”

Ureteroscopic Stone Management in Prepubertal Children

“…Large series using primarily rigid ureteroscopes with electrohydraulic, ultrasonic and holmium laser lithotripsy for distal ureteral stones have reported stone-free rates of 86-100% with low complication rates [11,12] . In a randomized study comparing URS and ESWL as primary therapies for distal ureteral stones in 31 children, De Dominicis et al [13] found significantly better stone-free rates in URS-treated patients. In our series of successful URS in children ^ 12 years, the overall complication rate was only 3.8%.…”