Ureteroscopy for stone disease in the paediatric population: a systematic review

Abstract

The aim of the present review was to look at the role of ureteroscopy (URS) for treatment of paediatric stone disease. We conducted a systematic review using studies identified by a literature search between January 1990 and May 2013. All English-language articles reporting on a minimum of 50 patients aged ≤18 years treated with URS for stone disease were included. Two reviewers independently extracted the data from each study. A total of 14 studies (1718 procedures) were reported in patients with a mean (range) age of 7.8 (0.25-18.0) years. The mean (range) stone burden was 9.8 (1-30) mm and the mean (range) stone-free rate (SFR) 87.5 (58-100)% with initial therapeutic URS. The majority of these stones were in the ureter (n = 1427, 83.4%). There were 180 (10.5%) Clavien I-III complications and 38 cases (2.2%) where there was a failure to complete the initial ureteroscopic procedure and an alternative procedure was performed. To assess the impact of age on failure rate and complications, studies were subcategorized into those that included children with either a mean age <6 years (four studies, 341 procedures) or a mean age >6 years. (10 studies, 1377 procedures). A higher failure rate (4.4 vs 1.7%) and a higher complication rate (24.0 vs 7.1%) were observed in children whose mean age was <6 years. URS for paediatric stone disease is a relatively safe procedure with a reasonably good SFR, but there seems to be a higher failure and complication rate in children aged <6 years.

Clinical effectiveness in the diagnosis and acute management of pediatric nephrolithiasis

“…45 A higher failure rate and higher complication rate (24.0 vs. 7.1%) were noted in children <6 years old compared to those older than 6 years. 45 Given the smaller caliber ureter in children, especially in infants and toddlers, some authors have recommended pre-stenting 2–8 weeks prior to URS to passively dilate the ureter and ureterovesical junction. 46 Others, however, have shown that primary ureteroscopic access can be achieved in 50–60% of children, including those that are prepubertal, with low complication rates.…”

“…42–44 One recent systemic review of URS identified 14 studies with over 1700 procedures in children aged 0.25 to 18 years old. 45 Mean stone-free rate was 87.5% and complications (Clavien I–III) were noted in 10.5% of patients including 3 patients with ureteral strictures and 18 patients with ureteral perforation (1.0%). 45 A higher failure rate and higher complication rate (24.0 vs. 7.1%) were noted in children <6 years old compared to those older than 6 years.…”

“…45 Mean stone-free rate was 87.5% and complications (Clavien I–III) were noted in 10.5% of patients including 3 patients with ureteral strictures and 18 patients with ureteral perforation (1.0%). 45 A higher failure rate and higher complication rate (24.0 vs. 7.1%) were noted in children <6 years old compared to those older than 6 years. 45 Given the smaller caliber ureter in children, especially in infants and toddlers, some authors have recommended pre-stenting 2–8 weeks prior to URS to passively dilate the ureter and ureterovesical junction.…”

Ureteroscopy for stone disease: expanding roles in the modern era

“…Evidence suggests that paediatric patients who undergo URS for urolithiasis have an overall SFR of 85.5–87.5% and an overall complication rate of 10.5–12.4% [18, 19]. It is worth noting that in subgroup analysis, patients below the age of 6 had a higher complication rate (24% vs. 7.1%) and failure rate (4.4% vs. 1.7%) than children over the age of 6 [18]. To achieve best outcomes, the management should be a combined multidisciplinary approach between paediatric, renal and urology teams.…”

Is the Economic Impact and Utilization of Imaging Studies for Pediatric Urolithiasis Across the United States Increasing?

“…A recent systematic review by Ishii et al found an initial URS procedure failed to reach completion in only 2.2% of children. 8 Meanwhile medical expulsive therapy has gained traction as well. 9 …”