Endoscopic hybridization in the treatment of complicated upper urinary calculus in children

Abstract

Complicated upper urinary calculi in children, such as staghorn stones or renal calculi with congenital malformation, are difficult to treat. Laparoscopy, flexible ureteroscopy and percutaneous nephroscopy are not effective enough when they were performed alone. In this research we retrospectively reviewed three kinds of cases which use two endoscopic modalities in the operation. We aimed to study the feasibility and safety of endoscopic hybridization. In one case with distal ureter stenosis complicated with renal calculi, the distal ureter was dissected by laparoscopy, then delivered via the laparoscope trocar. A 9.5/11.5F flexible ureteroscope sheath was inserted into ureter. Renal calculi were removed by flexible ureteroscopy. In one case of staghorn stones complicated with hydronephrosis, the child was placed in the oblique lithotomy position. Flexible ureteroscopy and percutaneous nephroscopy were perform at the same time to remove the calculi. In one case of duplex kidney with hydronephrosis of the lower moiety with calculi, nephropyeloplasty of the lower moiety by laparoscopy was performed initially. And 12/14F flexible ureteroscope sheath was inserted into the collecting system of the lower moiety through the laparoscopic trocar when the renal pelvis was open. Then the flexible ureteroscope was used to remove the calculi. All cases were successfully operated without obvious stone residue and major complications. Endoscopic hybridization can be applied safely in children.