Is cerebral palsy associated with successful ureteral access during the initial attempt at ureteroscopy for urolithiasis in children and young adults?

Abstract

Ureteroscopy is a common treatment for urolithiasis, but initial ureteral access is not always possible, particularly in pediatrics. Clinical experience suggests that neuromuscular conditions such as cerebral palsy (CP) may facilitate access, thus avoiding the need for pre-stenting and staged procedures. We sought to determine if probability of successful ureteral access (SUA) during initial attempted ureteroscopy (IAU) is higher in pediatric patients with CP vs. without CP. We reviewed IAU cases for urolithiasis (2010-2021) at our center. Patients with pre-stenting, prior ureteroscopy, or urologic surgical history were excluded. CP was defined using ICD-10 codes. SUA was defined as scope access to urinary tract level sufficient to reach stone. Association of CP and other factors with SUA were evaluated. 230 patients (45.7% male, median age: 16 years [IQR: 12-18y], 8.7% had CP) underwent IAU, with SUA in 183 (79.6%). SUA occurred in 90.0% of patients with CP vs. 78.6% of those without CP (p=0.38). SUA was 81.7% in patients >12 years (vs. 73.8% in those <12), and the highest SUA was in those >12 years with CP (93.3%), but these differences were not statistically significant. Renal stone location was significantly associated with lower SUA (p=0.007). Among patients with renal stone only, SUA in those with CP was 85.7% vs. 68.9% in those without CP (p=0.33). SUA did not differ significantly by gender or BMI. CP may facilitate ureteral access during IAU in pediatric patients, but we were unable to show a statistically significant difference. Further study of larger cohorts may demonstrate whether CP or other patient factors are associated with successful initial access. Improved understanding of such factors would help preoperative counseling and surgical planning for children with urolithiasis.