Interest of URS-L in the Treatment of Ureterolithiasis in Preschool Children

Outcomes of retrograde ureteroscopy in Chinese infants and toddlers under 3 years old with ureteric stones from a single center

INTRODUCTION

Pediatric urolithiasis is a less common disease with a steadily increasing incidence of 10.6 % per year. The comprehensive management of pediatric urolithiasis is more challenging than in adults, and published studies of endourological treatment in children have small sample sizes and older mean ages, which may not be representative of the overall pediatric population, especially in infants and toddlers. This study aimed to report results of retrograde ureteroscopy for treating pediatric ureteral stones in infants and toddlers (<3 years) from a single center in China.

METHODS

Demographic and surgical data of infants and toddlers with ureteral stones who underwent retrograde URS were retrospectively analyzed from January 2015 to September 2022.

RESULTS

The mean age of 100 infants (73 boys and 27 girls) was 19.6 ± 7.6 months and stone burden was 0.27 (0.11-0.52) cm³. 111 procedures were performed for all children due to 11 patients with bilateral ureteric stones were simultaneously treated. Among them, 70.3 % were semi-rigid URS, 12.6 % were Micro-URS and 17.1 % were flexible URS. SFR was up to 96 %, the median operation time and hospitalization days were 35.0 (25.0-50.0) minutes and 6.0 (5.0-6.0) days, respectively. 15 (15.0 %) infants had postoperative fever (Grade I), and complications above grade I were not observed.

DISCUSSIONS

This research reported the largest sample size of infant and toddler ureteric stones (under 3 years old) and shared optimal management strategies for these special populations. Compared to other related studies, we had a higher SFR due to diverse management strategies and reasonable application of pre-operative ureteric stents. The most important potential reason why our complication rate was relatively higher might be the younger population under 3 years old. In additionally, the reason of long hospitalization was maybe some patients underwent staged surgeries during one hospitalization. Those results indicated the robust effectiveness of URS for infants. This study has limitations, including its retrospective single-center design, absence of long-term follow-up data, and potential variability in surgical outcomes due to differences in surgeons' experience.

CONCLUSIONS

The experience of endourologic procedures for 100 infant and toddler patients with ureteric stones from a Chinese single center was reported. And URS showed its effectiveness and safety for those special populations based on its high SFR and low complication rate.

Outcomes of ureteroscopy for management of stone disease in early and late childhood over a 15-year period

Background

Although paediatric ureteroscopy is widely performed, there is still a lack of data and outcomes in early childhood. In this two-centre study, we compared the outcomes of ureteroscopy for stone disease management in early and late childhood and provide outcomes for the same.

Methods

Data was retrospectively collected on consecutive patients from two tertiary paediatric endo-urology European centres over a 15-year period (2006-2021). Patients were split into two groups, namely, early childhood (age ⩽ 9 years) and late childhood (age 9 to ⩽16 years). Outcomes including stone-free rate (SFR) and complications were compared between these two groups.

Results

A total of 148 patients underwent 184 procedures (1.2 procedure/patient) during the study period (66 in early childhood and 82 in late childhood). The mean age in early and late childhood groups were 5.6 and 13.3 years, and a male: female ratio of 1.6:1 and 1.1:1, respectively. The SFR and complications in early and late childhood groups were 87.8% and 90.2% (p = 0.64) and 5.7% and 4.1%, respectively.

Conclusion

Paediatric ureteroscopy and laser stone fragmentation achieves good results in both early and late childhood with comparable SFRs, although the complications and need for second procedure were marginally higher in the early childhood group. Our study would set up a new benchmark for patient counselling in future, and perhaps this needs to be reflected in the paediatric urolithiasis guidelines.

Therapeutic ureteroscopy for urolithiasis in children younger than 60 months of age

PURPOSE

The management of urinary tract calculi has evolved dramatically in children with the development of smaller and more durable endoscopic equipment. The indications for therapeutic ureteroscopy in children have significantly expanded with the availability of smaller caliber endoscopes and Holmium:YAG laser. In this paper, we review our experience of the management of urolithiasis and report outcomes of therapeutic ureterorenoscopy (URS) in children younger than 60 months.

METHODS

We retrospectively reviewed the inpatient, outpatient records, and imaging data of our hospital, of all children ≤ 60 months of age undergoing URS for the treatment of urinary stones.

RESULTS

During the study period; 77 children, mostly male (70.1%) presenting with a single calculus and a mean age of 28.97 ± 2.44 months underwent therapeutic URS. A majority of children (71.4%) had lower or mid-ureteric calculi. Pre URS double J (DJ) stenting was necessary for 21 (27.2%) children. A total of 24 (31.1%) children needed ureteric dilatation before the ureteroscopy. Post URS DJ stenting was necessary in 41 (53.2%) children. Stents were retrieved within 10 days of the procedure. Stone clearance rate following a single-stage URS procedure was 94.8%, and 4 (5.2%) children needed additional shockwave lithotripsy (SWL) to achieve stone clearance. Overall complication rate including hematuria and fever was 12.9% (10 patients).

CONCLUSION

Therapeutic ureterorenoscopy in the management of ureteric and selective renal pelvic calculi is safe and effective. It can be considered as the first-line therapy in young children.

Endourology Methods in Pediatric Population for Kidney Stones Located in Lower Calyx: FlexURS vs. Micro PCNL (MicroPERC®)

Kidney stone disease in children is always a therapeutic challenge. It is a multifactorial condition and it should be approached, diagnosed and treated as such. One of the biggest challenges is kidney stones located in the lower renal calyx. There are currently three main surgical techniques to treat this condition: ESWL-Extracorporeal Shock Wave Lithotripsy, RIRS-Retrograde IntraRenal Surgery, and PCNL-PerCutaneous Nephro-Lithotripsy. In pediatric population, the most frequently used method is ESWL, and in the event of failure, endoscopic procedures are the second-best choice. In this article, a sample of 53 children admitted to a tertiary medical center was examined. Thirty-eight of those children underwent flexible URS, while the remaining 15-micro PCNL. The average size of the deposit in the former group was 12.2 mm, against 13.5 mm in the latter. The full Stone Free Rate (SFR) was achieved in RIRS at 84.21 and 86.7% in percutaneous nephrolithotripsy. Flexible ureterorenoscopy and MicroPERC are two comparably effective methods for treating lower calyx stones of any size. However, according to our data, flexible ureterorenoscopy carries a lower risk of complications and inpatient care (with the mean of 3 days). The learning curve for these procedures in pediatric urology is long and relies on a limited number of patients. The number of pediatric patients qualifying for these procedures is restricted also due to the high efficacy of extracorporeal shock wave lithotripsy in pediatric population. Radiation exposure is an important factor in every endoscopy procedure and should never exceed the limits set in the ALARA protocol. ESWL remains to this day the treatment of choice for stone disease in children and can be performed under ultrasound control. For many parents, it is a first-choice treatment preference for their child due to its greater apparent safety, although data on this remains insufficient. Prospective, randomized, multicenter trials are definitely needed.

Surface analysis of ureteral stent before and after implantation in the bodies of child patients

The aim of this work was to determine which part of a double-J ureteral stent (DJ stents) showed the highest tendency to crystal, calculi, and biofilm deposition after ureterorenoscopic-lithotripsy procedure (URS-L) to treat calcium oxalate stones. Additionally, the mechanical strength and the stiffness of DJ stents were evaluated before and after exposure to urine. Obtained results indicated that the proximal (renal pelvis) and distal (urinary bladder) part is the most susceptible for post-URS-L fragments and urea salt deposition. Both, the outer and inner surfaces of the DJ ureteral stents were completely covered even after 7 days of implantation. Encrustation of DJ stents during a 31-day period results in reducing the Young’s modulus by 27–30%, which confirms the loss of DJ stent elasticity and increased probability of cracks or interruption. Performed analysis pointed to the need to use an antibacterial coating in the above-mentioned part of the ureteral stent to prolong its usage time and to prevent urinary tract infection.