Abstract
PurposeTo report the outcomes of paediatric ureteroscopy (URS) for stone disease from a specialist endourology centre in the UK. Ureteroscopy for management of stone disease has increased worldwide and is now being done more commonly in the paediatric age group.MethodsData were analysed retrospectively from a database maintained between April 2010 and May 2018. Consecutive patients ≤ 16 years of age undergoing semi-rigid or flexible URS for stone disease were included. Stone size and stone-free rate (SFR) were routinely assessed using an ultrasound (USS) and/or plain KUB XR. Complications were graded according to the Clavien–Dindo classification and recorded within 30 days post-procedure and readmissions within 90 days after the procedure were also captured.ResultsOver the 8-year period between April 2010 and April 2018, 81 patients with a mean age of 8.8 years (range 18 months–16 years) and a male to female ratio 1:1.1 underwent 102 procedures (1.28 procedure/patient to be stone free). Of the 81 patients, 29 (35.8%) had comorbidities, with 26 (32%) having multiple comorbidities. The mean (± SEM) single and overall stone size was 9.2 mm (± 0.48, range 3–30 mm) and 11.5 mm (± 0.74, range 4–46 mm) respectively, with 22 (27.1%) having multiple stones. Thirty-five (34.7%) had stent in situ pre-operatively. The stone location was in the ureter (26.6%), lower pole (35.4%), and renal pelvis (16.5%), with 22/81(27%) having multiple stones and 21/102 (20.5%) where a ureteral access sheath (UAS) was used.With a mean hospital stay of 1.2 days, the initial and final SFR was 73% and 99%, respectively, and 61/102 (60%) had ureteric stent placed at the end of the procedure. While there were no intra-operative complications, the readmission rate was less than 1% and there were only three early complications recorded. This included a case each of prolonged admission for pain control (grade I), urinary retention (grade II) and post-operative sepsis requiring a brief ITU admission (grade IV).ConclusionOur study demonstrates that in appropriate setting a high stone-free rate can be achieved with minimal morbidity for paediatric patients. There is potentially a need to factor the increasing role of URS in future paediatric urolithiasis guidelines.
Highlights
While paediatric urolithiasis remains rare, its incidence is rising [1, 2]
This study aims to report the outcomes of paediatric URS cases from a specialist endourology centre in the UK
Each case was discussed at a dedicated stone multidisciplinary team (MDT) meeting attended by an adult endourologist, paediatric urologist, interventional radiologist and biochemical pathologist
Summary
While paediatric urolithiasis remains rare, its incidence is rising [1, 2]. For those individuals affected by stone disease, recurrence can occur in up to 50% of cases [3, 4]. The evolution of minimally invasive surgical interventions such as ureteroscopy (URS) has been central to this process [5, 6]. Advancements related to optic systems, equipment and surgeon expertise have propelled URS as the intervention of choice for many paediatric stone cases [7, 8, 9]. Its uptake and dissemination has seen a marked rise across the world since the first description of its application in the paediatric setting in 1988 by Ritchey et al [10, 11, 12]
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