Retrograde ureteroscopy for distal ureteric stone removal in children

Abstract

A wide range of topics is covered in the Paediatric Urology section in this month's issue: retrograde ureteroscopy for distal ureteric stones, outcomes of continent catheterizable stomas for urinary and faecal incontinence, an exploration of a possible common cause between enuresis in childhood and urinary and faecal incontinence in adult life, and a description of a new surgical procedure, the colpo‐wrap.OBJECTIVETo compare the efficacy and safety of ureteroscopy plus intracorporeal lithotripsy (ULT) with extracorporeal shock wave lithotripsy (ESWL) for treating distal ureteric calculi in childhood, as such stones are commonly treated by ESWL as the first option in adults but there is no agreement on the method of treating them in children.PATIENTS AND METHODSFrom July 2002 to July 2003, children presenting with ureteric stones were consecutively randomized for treatment using ULT or ESWL. The two groups were matched for age, sex and stone position in the distal ureter. A 7.5 F ureteroscope combined with a ballistic lithotripter or holmium‐YAG laser was used for ULT. ESWL was administered using a second‐generation lithotripter. The success rate, effectiveness quotient, complication rate and hospitalization were evaluated and compared using Student's t‐test (chi‐square) and Fisher's exact test as appropriate. In all, 31 patients (21 girls and 10 boys, mean age 7.2 years, range 2–17) were treated, by ULT in 17 (12 girls and five boys) and ESWL as a primary procedure in 14 (five boys and nine girls).RESULTSAfter one ULT, all the girls and four boys, and after ESWL, four girls and two boys, were rendered stone‐free at the first treatment. The total stone‐free rate was 16 of 17 for ULT and six of 14 for ESWL (P = 0.004). Eight patients had a second ESWL and three then became stone‐free. The five patients in whom both ESWL treatments failed had a successful ULT. There was no significant difference between the groups in complication rate and hospitalization. General anaesthesia was required in all patients <12 years old treated by ULT or ESWL. The calculated efficiency quotient for treating distal ureteric calculi was significantly lower for ESWL than ULT (P < 0.05).CONCLUSIONSULT should be recommended as the treatment of choice for distal ureteric calculi in children; using small ureteroscopes the target stone was treated safely and effectively.