Abstract
Purpose:
We present our experience performing ureteroscopy in prepubertal children.
Materials and Methods:
We performed a retrospective cohort study of children 12 years or younger who underwent ureteroscopy at 2 institutions between 1993 and 2003. Patient demographics, indications for surgery, operative technique, surgical outcomes and complications were recorded.
Results:
A total of 39 boys and 32 girls underwent 34 flexible and 47 rigid ureteroscopies. Retrograde access was obtained in 77 procedures, while 4 were performed via an antegrade approach. Mean age was 7.5 years (range 1 to 12) and mean followup was 2.2 years (0.5 to 10). Endoscopic lithotripsy was performed in 65 cases, with a success rate of 98%. A ureteral stent was placed postoperatively in 55 patients. Endoscopic incision was performed for a ureteral stricture in 3 patients and for ureteropelvic junction obstruction in 6. An obstructing fibroepithelial polyp was found in 2 patients, 1 underwent removal of a foreign body and 4 did not have intraluminal pathology. Dilation of the ureteral orifice was required in 23 cases (30%). There were no intraoperative ureteral injuries. One patient had development of a ureteral stricture (complication rate 1.3%) that was successfully treated endoscopically.
Conclusions:
Rigid and flexible ureteroscopy can be performed safely and effectively in prepubertal children. Successful outcomes can be obtained for calculi that are similar to those in the adult population. Ureteroscopic treatment can be effective in selected children with intraluminal obstruction. To our knowledge this is the largest series in the literature to document outcomes of ureteroscopy in this age group.
References
- 1 : Safety and efficacy of pediatric ureteroscopy for management of calculous disease. J Urol1993; 149: 1082. Link, Google Scholar
- 2 : Experience with ureteroscopy in children. Br J Urol1995; 75: 395. Crossref, Medline, Google Scholar
- 3 : Endoscopic treatment of pediatric urolithiasis. J Pediatr Surg1996; 31: 1413. Google Scholar
- 4 : Pediatric ureteroscopy: technique and preliminary results. J Pediatr Surg1997; 32: 571. Crossref, Medline, Google Scholar
- 5 : Holmium:YAG lithotripsy in children. J Urol1999; 162: 1717. Link, Google Scholar
- 6 : Paediatric ureteroscopy for ureteric calculi: a 4-year experience. Br J Urol1997; 80: 797. Google Scholar
- 7 : Transureteral lithotripsy in pediatric practice. J Endourol2002; 16: 257. Google Scholar
- 8 : Ureteroscopy for the treatment of urolithiasis in children. J Urol2002; 167: 1813. Link, Google Scholar
- 9 : Strategies for managing upper tract calculi in young children. J Urol1999; 162: 1234. Link, Google Scholar
- 10 : Congenital valvular obstruction of the prostatic urethra. Surg Gynecol Obstet1929; 48: 509. Google Scholar
- 11 : Urolithiasis in children: innovations in management. J Urol1988; 140: 790. Link, Google Scholar
- 12 : A case of pediatric ureteroscopic lasertripsy. J Urol1988; 139: 1272. Link, Google Scholar
- 13 : Treatment of distal ureteral stones in children: similarities to the American Urological Association guidelines in adults. J Urol2000; 164: 1089. Link, Google Scholar
- 14 : Initial experience with endoscopic holmium laser lithotripsy for pediatric urolithiasis. J Urol1999; 162: 1714. Link, Google Scholar
- 15 : Pediatric ureteroscopy. Urol Clin North Am2004; 31: 145. Google Scholar
- 16 : Routine ureteral stenting after ureteroscopy for ureteral lithiasis: is it really necessary?. J Urol2001; 166: 1252. Link, Google Scholar
- 17 : Comparison of symptom characteristics of indwelling ureteral catheters. J Urol1991; 145: 719. Link, Google Scholar
- 18 : Endoscopic management of renal hemangioma. J Urol2002; 167: 488. Link, Google Scholar
- 19 : Successful endoscopic management of pediatric renal hemangiomas with silver nitrite instillation. J Endourol2003; 17: A204. Google Scholar
- 20 : Ureteropelvic junction obstruction: determining durability of endourological intervention. J Urol2004; 171: 579. Link, Google Scholar
From the Cincinnati Children's Hospital, Cincinnati, Ohio, and Nemours Children's Clinic, Jacksonville, Florida (ME)
