Efficacy and safety of endoscopic treatment of ureteral stones in pediatric age

Ureteroscopy procedures in pediatric age are becoming more and more common
thanks to the availability of smaller caliber instruments, and of improved endoscopic techniques.
The efficacy of this procedure in pediatric age is still discussed nowadays.
This paper aims at reviewing all cases of ureteral lithiasis treated by ureteroscopy plus intracorporeal
lithotripsy (ULT), as well as verifying efficacy and safety of this procedure in
pediatric age.
MATERIALS AND METHODS. From July 2002 to May 2006, 37 patients (26 female, 11 male; mean
age 7.4 years; range 2-17) were treated by ULT for ureteral stones: 30 in distal, 4 in middle
and 3 in proximal ureter. Median size of stones was 7mm (range 3-13mm). Dilation of the
ureteral meatus was necessary in 2 patients only. Endoscopic procedure was similar to adult
patients. Outcomes were statistically compared with current literature data.
RESULTS. In 36 (97.3%) out of 37 patients ULT proved successful. All patients having stones
in distal (30) and middle (4) ureter were stone-free at the end of treatment. Stone migration
into the kidney pelvis occurred in 1 patient with proximal ureter stones (66.7% stone-free
rate): an ESWL treatment was therefore performed. 1 case only (2.7%) developed a perioperative
complication (stone migration). Hematuria and flank pain in 4 patients (10.8%)
were the most common reported post-operative complications. A stone-free state was confirmed
at 1 and 3 months for all 36 patients. There was no evidence of ureteral strictures
and/or ureteral refluxes. CONCLUSIONS. Smaller caliber ureteroscopes confirmed ULT as the
first-choice treatment procedure in children affected by ureteral lithiasis, thanks to its efficacy
and safety.