Ureteroscopic Treatment of Kidney Stones in Children Found Safe

Ureteroscopy is a safe method for the treatment of intrarenal calculi in prepubescent children, claims a new study.

Researchers at Vanderbilt Children's Hospital (Nashville, TN, USA) retrospectively reviewed ureteroscopic procedures for kidney stone removal in children younger than 14 years conducted between January 2002 and December 2007. The study included 50 children (52 kidneys) who had intrarenal calculi; the mean age of the group was 7.9 years, and mean stone size was eight mm. Subsequent stone-free status was determined with postoperative imaging. Multiple logistic regression analysis was used to assess the influence of preoperative factors on initial stone-free status and the need for additional procedures.

The study results showed that stone free rate after a single ureteroscopic procedure was 50% on initial postoperative imaging, and 58% with extended follow-up. The researchers found that the initial stone-free status was dependent on preoperative stone size, but not the actual location. Younger patient age and patients who hade stones greater than six mm were associated with the need for additional procedures, which were required in 18 upper urinary tracts.

"Ureteroscopy is a safe method for the treatment of intrarenal calculi in the prepubertal population,” concluded lead author Stacy Tanaka, M.D., and colleagues of the division of pediatric urology. "Parents should be informed that additional procedures will likely be required, especially in younger patients and those with stones larger than six mm.”

Ureteroscopy is defined as upper urinary tract endoscopy performed most commonly with an endoscope passed through the urethra, bladder, and then directly into the upper urinary tract. Indications for ureteroscopy have broadened from diagnostic endoscopy to various minimally invasive therapies, such as endoscopic lithotripsy. Treatment of upper urinary tract urothelial malignancies, stricture incisions, and ureteropelvic-junction obstruction repair are all current treatments facilitated by contemporary ureteroscopic techniques. With improved instrumentation and evolution of surgical technique, the complication rate associated with ureteroscopy has decreased significantly.

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