Flexible ureterorenoscopy and laser lithotripsy in children

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Abstract

Background:

Flexible ureterorenoscopy (FUR) and laser lithotripsy (LL) are techniques used in the management of upper urinary tract disorders. These techniques, so far established in adults, are now being used in children as well. We report our experience with 26 cases of pediatric upper urinary tract disorders treated using these techniques.

Methods:

In the period from 1997 to 2006, FUR was performed in 26 children (14 males and 12 females) in the age group of three months to 15 years with a mean age of 8.2 years. Twenty five were stented prior to undergoing FUR and 24 presented with suspected upper tract stones (17 pelvicalyceal and seven midureteric). Two cases showed JJ stent migration post-pyeloplasty.

Results:

Eight cases involved diagnostic procedures. Six excluded the presence of renal calculi, one had focal medullary sponge kidney, and one had calcified papillae. There were 15 cases of therapeutic FUR. Of these, 12 had LL with only one had incomplete stone fragmentation which subsequently passed spontaneously. Other therapeutic procedures included removal of migrated JJ stents and FUR with the basket removal of a midureteric calculus. Three cases failed ureterorenoscopy due to technical difficulties. The overall success rate was 88.5% for FUR.

Conclusion:

FUR and LL are valuable minimally invasive techniques for the examination and treatment of pediatric upper urinary tract conditions. Preoperative stenting improves passage of the ureteroscope and with progressive miniaturization of instruments, the lower weight limit will decrease.

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Most cited references 4

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Treatment of distal ureteral stones in children: similarities to the american urological association guidelines in adults.

J G Van Savage, L G Palanca, R Andersen … (2000)

The American Urological Association (AUA) published clinical guidelines for the treatment of ureteral calculi in adults and note that up to 98% of stones less than 5 mm. in diameter will pass spontaneously. Ureteroscopy and shock wave lithotripsy were acceptable treatment choices for stones less than 10 mm. in diameter in the distal ureter. We reviewed our management of distal ureteral stones in children to see if the AUA Guidelines for adults would apply. A total of 14 males and 19 females with a mean age of 12 years (range 0.5 to 17) required hospitalization in the last 6 years for distal ureteral obstruction due to stones. Excretory urography or computerized tomography was performed in all cases, and mean stone size was 4 mm. (range 1 to 15). When stones did not pass spontaneously most patients were treated with ureteroscopic laser lithotripsy. There were 12 (36%) with a mean age of 11 years and a mean stone size of 2 mm. (range 1 to 3) who passed stones spontaneously with intravenous hydration and narcotics. No child passed a stone 4 mm. or greater spontaneously in this series. Of 21 patients (64%) with a mean age of 12 years and a mean stone size of 5 mm. (range 1 to 15) 2 were treated with ureteral stents, 17 with ureteroscopic lithotripsy and 2 with shock wave lithotripsy. All patients were stone-free at the end of the procedures. The stone composition was predominantly calcium oxalate. Mean followup was 2 years. Similar to the AUA guidelines in adults, most stones less than 3 mm. in diameter in the distal ureter of children will pass spontaneously. Stones 4 mm or greater in the distal ureter are likely to require endosurgical treatment. Ureteroscopy and shock wave lithrotripsy have a high success rate for stones between 4 and 15 mm. in the distal ureter. Needle ureteroscope and laser lithotripsy have allowed more stones to be treated safely and effectively in smaller children.

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Ureteral access sheath for the management of pediatric renal and ureteral stones: a single center experience.

Amar Singh, Gaurang Shah, Jennifer Young … (2006)

Ureteral access sheaths were developed to facilitate difficult ureteroscopic access in adults. We report our use of the ureteral access sheath during standard ureteroscopic procedures in the pediatric stone population. Eight patients underwent flexible ureteroscopy and holmium laser lithotripsy for symptomatic renal and ureteral calculi between October 2003 and October 2004. Average patient age was 9.3 years (range 4 to 13). There were 4 males and 4 females. Five of 8 patients had bilateral stones and underwent bilateral endoscopic stone treatment at the same operation. A 14Fr 20 cm Flexor ureteral access sheath was used for dilation and access of the ureter. Flexible pediatric ureteroscope was used to enter the ureter and collecting system for stone retrieval and fragmentation. All patients were rendered stone-free in a single operative setting. Average operative time was 99 minutes (range 65 to 130). Average total stone burden for the group was 9 +/- 3 mm. All patients received stents after the procedure. There were no perioperative complications. All patients were followed with renal-bladder ultrasound and plain x-ray. All patients were stone-free at a mean followup of 10 months (median 11). Routine use of a ureteral access sheath in children facilitates flexible ureteroscopy with lithotripsy of multiple renal and proximal ureteral stones. The procedure is safe and time efficient, and is associated with minimal morbidity. Larger prospective studies in children with longer followup are warranted.

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Holmium:YAG lithotripsy in children.

T Wollin, J M Teichman, V J Rogenes … (1999)

We determined the safety and efficacy of holmium:YAG lithotripsy in children. We retrospectively reviewed the records of all holmium:YAG lithotripsy done in patients 17 years old or younger. Demographic, preoperative, intraoperative and postoperative data were collected. A total of 9 boys and 10 girls (26 stones) with a mean age of 11 years (range 1 to 17) were treated with holmium:YAG lithotripsy, which was chosen as initial therapy in 10 (53%). Retrograde ureteroscopy was performed in 15 patients to treat 13 ureteral and 6 renal calculi, and percutaneous nephrolithotripsy was done in 4 to treat 3 ureteral and 4 renal calculi. A complete stone-free outcome after 1 procedure was achieved in 16 children (84%) and 3 patients were rendered stone-free after 2 procedures. No patient had an intraoperative injury. Followup ranged from 0.5 to 12 months (mean 3). Followup imaging has shown no evidence of stricture or hydronephrosis. Holmium:YAG lithotripsy is safe and effective in children. It is a reasonable option for failed shock wave lithotripsy, or in children with a known durile stone composition or contraindications to shock wave lithotripsy.

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Author and article information

Journal

Journal ID (nlm-ta): J Indian Assoc Pediatr Surg

Journal ID (publisher-id): JIAPS

Title: Journal of Indian Association of Pediatric Surgeons

Publisher: Medknow Publications (India )

ISSN (Print): 0971-9261

ISSN (Electronic): 1998-3891

Publication date (Print): Apr-Jun 2009

Volume: 14

Issue: 2

Pages: 63-65

Affiliations

Department of Pediatric Surgery, Princess Margaret Hospital, Roberts Road, Subiaco, Western Australia 6008

Author notes

Address for correspondence: Dr. Andrew Barker, Princess Margaret Hospital for Children, Roberts Road, Subiaco, WA 6008, Australia. E-mail: Andrew.Barker@ 123456health.wa.gov.au

Article

Publisher ID: JIAPS-14-63

DOI: 10.4103/0971-9261.55154

PMC ID: 2905533

PubMed ID: 20671848

SO-VID: 1e25e6c7-d841-46fb-9eac-30f2cb780589

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Flexible ureterorenoscopy and laser lithotripsy in children

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Abstract

Background:

Methods:

Results:

Conclusion:

Related collections

Chinese Journal of General Practice

Most cited references 4

Treatment of distal ureteral stones in children: similarities to the american urological association guidelines in adults.

Ureteral access sheath for the management of pediatric renal and ureteral stones: a single center experience.

Holmium:YAG lithotripsy in children.

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