Flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants

Abstract

We evaluated the clinical value of flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants. Fiftyfive infants with upper urinary tract calculi were included in this study: 41 males and 14 females. Retrograde intrarenal surgery was performed by an 8 Fr/30 cm flexible ureterorenoscope (POLY Õ ) combined with a holmium laser. CT scanning or radiography of the kidneys, ureters, and bladder region was performed one month after the operation to confirm the clearance of calculi. All the 55 infants with calculi in 74 sides underwent 66 flexible ureteroscopic lithotripsy procedures. The median operation time was 30 min. The median amount of flushing fluid was 500 mL. The stone-free rate after a single session treatment was 94.6%, within which 10 infants underwent simultaneous bilateral flexible ureteroscopy lithotripsy. Catheters were retained in 45 infants for 24-48 h after the operation. Continuous high fever due to reflux was present in two cases. Flushing fluid extravasation was found in one infant. Some patients with minor complications, such as mild hematuria, irritation symptoms, and low fever, recovered without treatment. The duration of hospitalization time after the operation was approximately 1-5 days. Flexible ureteroscopic lithotripsy is a safe, highly efficient, minimally invasive, and reproducible operation for removal of upper urinary tract calculi in infants. This technique is a convenient method for postoperative management of patients that enhances their rapid recovery. It is a promising option for therapy of infants ineffectively treated by extracorporeal shockwave lithotripsy.

Prevalence of kidney stones in mainland China: A systematic review

“…The management of nephrolithiasis has changed a great deal over the past decades; considerable increase in flexible ureteroscopy and decrease in extra-corporeal shockwave lithotripsy and percutaneous nephrolithotomy were observed in Australia 50 , UK 51 , and other countries 52 . In mainland China, less invasive techniques have been widely used; flexible ureteroscopy procedures were not only performed in adults, but also in pediatric patients 53 .…”

Outcomes of miniaturized percutaneous nephrolitotomy in infants: single centre experience

“…Li et al published first series of RIRS in infant patient with SFR of 94.6%. Ten out of 55 infants underwent simultaneous bilateral RIRS ( 17 ). One of the major problems during the procedure in this age group of patient was ureteral access sheath (UAS) insertion.…”

“…In reported series of pediatric RIRS, UAS was inserted in 43.7-61.5% of patients ( 16 - 18 ). Li et al did not use UAS, rather they inserted DJ stent in all patients before the procedure and after a while 8Fr f-URS was advanced over the hydrophilic guidewire ( 17 ). Generally, major complications were not observed in these procedures.…”

Outcomes of miniaturized percutaneous nephrolitotomy in infants: Single centre experience

“…Generally, major complications were not observed in these procedures. Urinary system infection, postoperative hematuria, ureteral mucosal injury and ureteral perforation were the most commonly observed complications in pediatric RIRS series (16,17).…”

“…The younger the child was, the harder the insertion of UAS. In reported series of pediatric RIRS, UAS was inserted in 43.7-61.5% of patients (16)(17)(18). Li et al did not use UAS, rather they inserted DJ stent in all patients before the procedure and after a while 8Fr f-URS was advanced over the hydrophilic guidewire (17).…”