THE URETEROSCOPIC TREATMENT OF PROXIMAL URETERAL AND INTRARENAL COLLECTING SYSTEM CALCULI IN THE PEDIATRIC POPULATION

• Published in: Pediatrics (Evanston) 1999-09, Vol.104 (3), p.833-833
• Main Authors: Erhard, Michael J, Barraza, Mark A
• Format: Article
• Language: English
• Subjects: Pediatrics; Ureteroscopy
• ISSN: 0031-4005; 1098-4275

Introduction: The treatment of urinary calculi has evolved due to the development of miniature endoscopes and laser lithotripsy. Shock wave lithotripsy (SWL) is considered the first line treatment for most upper collecting system calculi. Ureteroscopy has been shown to be safe and effective in adults but large scale data regarding its use in children is yet to be accumulated. Presented here is our initial data regarding the endoscopic treatment of proximal ureteral and intrarenal calculi in children. Methods: Patients who have undergone ureteroscopy for treatment of proximal calculi are presented. Indications for intervention include acute obstruction, nonspontaneous passage, persistent gross hematuria, and significant stone burden. When necessary, holmium laser lithotripsy was utilized. Postoperatively all patients were evaluated by either intravenous pyelogram, ultrasound, or abdominal x-ray to assess for changes associated with their treatment. All procedures were performed with either a 6.9 Fr minirigid or 7.4 Fr flexible ureteroscope. Results: Twelve patients (8 male, 4 female) underwent 18 procedures (10 ureteral, 8 renal) from 7/97 to 12/98. Mean age was 9.0 years (13 mos.-17yrs); 9 were prepubertal and 3 postpubertal. One patient has primary hyperoxaluria and one primary hyperparathyroidism requiring multiple procedures until metabolically controlled. One patient has a history of a prior bilateral Cohen ureteral reimplantation. All patients were done on either an outpatient (14) or overnight (4) basis. 5/18 required dilatation prior to placement of the flexible ureteroscope (3 graduated dilator, 2 balloon). Ten/10 ureteral calculi were successfully removed with one treatment. Six/8 (75%) renal calculi were successfully treated with ureteroscopy. One failed due to mechanical trouble (breakdown of laser and failure of electrohydrolic lithotripsy) and required auxiliary SWL; one radiolucent lower pole calculus could not be engaged for endoscopic lithotripsy or removal. Five/6 renal stones were cleared at the initial setting. All patients had stents postoperatively, 15/18 with a dangler string to facilitate removal without anesthesia. None were removed prematurely. One child required subsequent endoscopic incision of a distal ureteral stricture (balloon dilatation at time of initial procedure). No other significant changes were noted on postoperative imaging. Conclusion: The endoscopic treatment of proximal collecting system calculi in children appears