Pediatric ureteroscopy is safe and effective for treating all upper ureter calculi, but complete stone clearance after a single ureteroscopy is more effective if the calculi is single, under 10 mm in diameter, and below the level of pelviureteral junction (PUJ), according to a study.
Rajendra Nerli, MD of Jawaharial Nehru Medical College in Belgaum, India, and colleagues analyzed presentation, operative access, intraoperative complications, stone-free rates, and postoperative complications in children with upper ureteral stones treated ureteroscopically. A total of 80 children (69 boys and 11 girls) underwent 88 ureteroscopic procedures between January 2002 and December 2009. The mean age of the children was 9.5 years (range: 6-12 years). The mean stone diameter was 10.18 mm (range: 7- 16 mm) Of the 80 patients, eight (10%) had two or more calculi. The others had only one.
In 72 children (90%), complete stone clearance was achieved in a single ureteroscopic session. In six other patients (7.5%), complete stone clearance was achieved after a second ureteroscopic session, Dr. Nerli’s team reported in the Journal of Endourology (2011;25:579-582).
In the remaining two patients, residual stone fragments were observed in the lower and middle calyx. Both of these patients required shockwave lithotripsy. The mean size of the stones in patients who did not achieve complete stone clearance in one session was 13 mm.
After a mean follow-up of 20.4 months, the investigators observed no major intraoperative complications in any of the 80 patients. Intraoperative bleeding occurred in six patients; eight patients experienced postoperative bleed that resolved on its own within one day. An analysis of the stones showed that 87.5% were pure calcium oxalate stones, and 7.5% were mixed calcium oxalate and uric acid stones. The remaining 5% were mixed calcium phosphate oxalate and urate stones.