Therapeutic ureteroscopy for urolithiasis in children younger than 60 months of age.

ABSTRACT

PURPOSE: The management of urinary tract calculi has evolved dramatically in children with the development of smaller and more durable endoscopic equipment. The indications for therapeutic ureteroscopy in children have significantly expanded with the availability of smaller caliber endoscopes and HolmiumYAG laser. In this paper, we review our experience of the management of urolithiasis and report outcomes of therapeutic ureterorenoscopy (URS) in children younger than 60 months. METHODS: We retrospectively reviewed the inpatient, outpatient records, and imaging data of our hospital, of all children ≤ 60 months of age undergoing URS for the treatment of urinary stones. RESULTS: During the study period; 77 children, mostly male (70.1%) presenting with a single calculus and a mean age of 28.97 ± 2.44 months underwent therapeutic URS. A majority of children (71.4%) had lower or mid-ureteric calculi. Pre URS double J (DJ) stenting was necessary for 21 (27.2%) children. A total of 24 (31.1%) children needed ureteric dilatation before the ureteroscopy. Post URS DJ stenting was necessary in 41 (53.2%) children. Stents were retrieved within 10 days of the procedure. Stone clearance rate following a single-stage URS procedure was 94.8%, and 4 (5.2%) children needed additional shockwave lithotripsy (SWL) to achieve stone clearance. Overall complication rate including hematuria and fever was 12.9% (10 patients). CONCLUSION: Therapeutic ureterorenoscopy in the management of ureteric and selective renal pelvic calculi is safe and effective. It can be considered as the first-line therapy in young children.