Pediatric Ureteroscopic Management Of Intrarenal Calculi

Main Category: Pediatrics / Children's Health
Also Included In: Urology / Nephrology
Article Date: 12 Jan 2009 - 1:00 PDT

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UroToday.com - With the advent of smaller flexible ureteroscopes, upper tract stone disease in children has increasingly been treated using the ureteroscopic approach.

These pediatric researchers from Monroe Carell Jr. Children's Hospital at Vanderbilt reported on 50 children under the age of 14 years (mean age 7.9 years) who were managed ureteroscopically for intrarenal calculi. The mean stone size was 8 mm (range 1-16 mm). Half of theses stones were located in the renal pelvis or UPJ, while 25% were in the lower pole, and the remainder were in other pole calices. The majority of post ureteroscopy imaging, 57%, was with renal ultrasound, a third were imaged with CT scan, and 10% had abdominal plain films. The stone-free rate after a single ureteroscopic procedure was 50% upon initial post-operative imaging but increased to 58% at three months follow-up. More than half of the patients had preoperative ureteral stents to passively dilate the ureter.

Additional stone procedures were associated with younger patient age, larger preoperative stone size and specifically stones > 6 mm. Preoperative stent placement did not significantly increase stone-free status, however, the authors feel this facilitates proximal ureteroscopy.

These clinicians concluded that ureteroscopy is the safe method for treatment of prepubertal children with intrarenal calculi. In young children with large stone burden, parents should be advised of the likelihood of additional procedures to render these patients stone-free.

Tanaka ST, Makari JH, Pope JC 4th, Adams MC, Brock JW 3rd, Thomas JC
J Urol. 2008 Nov;180(5):2150-4.
doi:10.1016/j.juro.2008.07.079

Written by UroToday.com Contributing Editor Elspeth M. McDougall, MD, FRCSC, MHPE

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