Ureteroscopy for Stone Disease in Paediatric Population is Safe and Effective in Medium-Volume and High-Volume Centres: Evidence from a Systematic Review

Abstract

Purpose of ReviewThe incidence of urinary stone disease among the paediatric population is increasing. Whilst there has been a rise in the number of original studies published on ureteroscopy (URS) in children, critical review still remains under-reported.Recent FindingsA Cochrane style systematic review was performed to identify all original articles on URS (minimum of 25 cases) for stone disease in paediatric patients between Jan. 1996 and Dec. 2016. Based on the number of reported cases, centres were divided into medium (25–49 cases) and high (≥ 50 cases) volume studies.Thirty-four studies (2758 children) satisfied our search criteria and were included in this review. The mean stone size was 8.6 mm with an overall stone-free rate (SFR) of 90.4% (range 58–100). Medium-volume centres reported a mean SFR of 94.1% (range 87.5–100), whilst high-volume centres reported a mean SFR of 88.1% (range 58–98.5). Mean number of sessions to achieve stone-free status in medium-volume and high-volume groups was 1.1 and 1.2 procedures/patient respectively. The overall complication rate was 11.1% (327/2994). Breakdown by Clavien grade was as follows: Clavien I 69% and Clavien II/III 31%. There were no Clavien IV/V complications, and no mortality was recorded across any of the studies. The overall failure to access rate was 2.5% (76/2944).Medium-volume and high-volume studies had overall complication rates of 6.9% (37/530) and 12.1% (287/2222) respectively, but there was no significant difference in major or minor complications between these two groups.SummaryUreteroscopy is a safe and effective treatment for paediatric stone disease. Medium-volume centres can achieve equally high SFRs and safety profiles as high-volume centres. Despite the rarity of paediatric stone disease, our findings might increase the uptake of paediatric URS procedures.

Outcomes of ureteroscopy (URS) for stone disease in the paediatric population: results of over 100 URS procedures from a UK tertiary centre

“…A recent study by Pietropaolo et al reveals that over the past 20 years, while SWL has been the most common treatment modality, in more recent years the dissemination of URS has risen markedly [10]. Rob et al reported that there was no significant difference in the complication rates of URS (both major and minor) between medium and highvolume paediatric centres [24]. A recent meta-analysis by Geraghty et al also found the overall cost of URS procedure to be lower than SWL ($2801) compared to SWL ($3627) ($2801 vs. $3627, p = 0.03) [25].…”

Guidewire for Retrograde Passive Dilatation of Ureter in Pediatric Patients with Urolithiasis: A Novel Technique from a Tertiary Center in Nepal

“…Another study by Carry W. Jr. Herdon reported only 13.79% of the pediatric ureteric stone patients needed preoperative PUD [16].The overall failure to access rate was 2.5% in a Cochrane style systemic review [17].…”

“…However, URS for the management of ureteric stone in children is a relatively safe procedure [11]. According to the Cochrane style systemic review, the overall complication rate was 11.1% (MCCS -I = 69% and MCCS -II/III = 31%) [17].…”

Update on Surgical Management of Pediatric Urolithiasis

“…A complication rate of 11.1% (327/2,994) was reported; 69% of these were Clavien grade I, and 31% were grade II/III. There were no Clavien grade IV and V complications (84). In another multicenter study of 642 children where semirigid ureterorenoscopy was performed for ureteric stones, a total of 54 (8.4%) complications have been documented where operative time was the only statistically significant parameter affecting the complication rate (78).…”