Single-institutional study on role of ureteroscopy and retrograde intrarenal surgery in treatment of pediatric renal calculi.

摘要

OBJECTIVES: Ureteroscopy (URS) is accepted as a primary modality to treat ureteral calculi in children and extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy continue to be the primary option for renal stones. We report our experience with the use of URS in managing pediatric upper tract calculi and evaluate the results in relation to stone location, size, and the use of URS as a primary or secondary treatment modality. METHODS: A retrospective chart review was performed for all children who underwent URS for renal stones from 1999 to 2004. Success was defined as complete radiologic clearance. RESULTS: A total of 19 patients (mean age 6.9 years) with 23 calculi underwent URS and were followed up for a mean of 23 months. The stones were located in the renal pelvis in 8 patients, and the polar regions in 4 and 7 patients had partial staghorn calculi with >1 caliceal extension. The primary and secondary success rate for patients with renal calculi was 80% (5 of 8) and 66% (2 of 3) for pelvic stones and 100% (4 of 4) for polar stones. Only 1 of the partial staghorn calculi was completely cleared with URS. Complications included distal ureteral perforation in 1 and urinoma in 1. CONCLUSIONS: URS achieves reasonable results with minimal complications in pediatric patients with renal pelvic calculi. Polar stones required multiple sessions for complete clearance, and staghorn calculi were not amenable to URS. Additional studies are necessary to define the role of URS as an option in the surgical treatment of children with renal calculi.