RIGID URETEROSCOPY FOR THE TREATMENT OF URETERAL CALCULI IN CHILDREN

Abstract

We assess the safety and efficacy of rigid ureteroscopy for the treatment of pediatric ureterolithiasis. The records of 33 children with an average age of 7.4 years (range 9 months to 15 years) treated with rigid ureteroscopy between May 1995 and July 2003 were reviewed. In 35 ureteral units use of a rigid 6.9 to 10Fr ureteroscope was planned for treating stones at various levels of the ureter. Stones were located in the upper ureter in 6 cases, middle ureter in 3 and lower ureter in 26. Dilatation of the ureteral orifice was necessary in 11 cases. Stone size varied from 3 to 10 mm (mean 5.3). In 33 patients (94%) all stone fragments were removed successfully. Stones were fragmented with pneumatic lithotripsy in 20 cases and removed by forceps without fragmentation in 13. In 1 child an upper ureteral stone migrated up to the kidney during ureteroscopy but following extracorporeal shock lithotripsy therapy she was rendered stone-free. In another child it was not possible to remove the stone. In a 9-month-old female patient with bilateral stones it was not possible to enter the left ureter because of a tight orifice resistant to balloon dilation. At the end of the procedure a 3 or 4Fr ureteral or a 4.8Fr Double-J (Medical Engineering Corp., New York, New York) stent was left in place for 3 days to 3 weeks in 12 cases. There were no cases of ureteral perforation. Of the patients 31 were followed for 1 to 36 months. No incidence of vesicoureteral reflux was detected in 9 who underwent postoperative cystography. After becoming experienced and meticulously working with finer instruments in adults, rigid ureteroscopy can be a safe and efficient treatment for ureteral stones in every location in children.