Endoscopic ureterolithotripsy in paediatrics: when and why?
Purpose Ureteral stones in children are uncommon (7% in adulthood).There is no consensus on the best treatment. The small calibre of instruments has increased their efficacy in the paediatric population. We retrospectively evaluated the efficacy and safety of our endoscopic ureterolithotripsy (ULT) . Material and methods From July 2002 to May 2006, 32 patients, 26 females and 11 males (mean age 7.4 years, range 2-17 years) underwent ULT. Two guide-wires,a 7.5 F ureteroscope and ballistic energy were used, under X-ray control. If necessary, the ureteral orifice was dilated with 6-9 F semirigid dilatators. Antimicrobial prophylaxis was started 24 hours before the procedure. Ultrasound and X-ray at 1 and 3 months were adopted as follow-up. Results Position of the ureteral stones and results are summarized in the table. The mean stone diameter was 7 mm (range 4-13). 36 out of 37 patients (97.3%) were stone-free after 1 ULT. One proximal ureteric stone migrated to the pelvis and required subsequent ESWL. In 2 children ureteral orifice dilatation was necessary. Minor postoperative complications occurred in 4 patients (10.8%): mild haematuria and flank pain. No ureteral stenosis or UTI/reflux was observed. All the 36 patients were stone free at 3 months follow-up. Stone position N: pts % Stone-free % Distal ureter 30 81.1 30 100 Middle ureter 4 10.8 4 100 Proximal Ureter 3 8.1 2 66.7 Conclusions Smaller ureteroscopes and accurate endourological procedures allow us to consider ULT as the first choice of treatment for ureteral stones in paediatrics; ULT safety and efficacy has been confirmed in children younger than 3 years.