Management of ureteric stone in pediatric patients

Abstract

The management of ureteral stones in children is becoming more similar to that in adults. A number of factors must be taken into account when selecting one's choice of therapy for ureteral stone in children such as the size of the stone, its location, its composition, and urinary tract anatomy. Endoscopic lithotripsy in children has gradually become a major technique for the treatment of ureteral stones. The stone-free rate following urteroscopic lithotripsy for ureteral stones has been reported in as high as 98.5-100%. The safety and efficacy of Holmium:YAG laser lithotripsy make it the intracorporeal lithotriptor of choice. Given its minimally invasive features, extracorporeal shock wave lithotripsy (ESWL) has become a primary mode of treatment for the pediatric patients with reno-ureteral stones. Stone-free rates have been reported from 59% to 91% although some patients will require more than one treatment session for stone clearance. It appears that the first-line of therapy in the child with distal and mid-ureteral stones should be ureteroscopic lithotripsy. While ESWL is still widely considered the first-line therapy for proximal ureteral calculi, there is an increasing body of evidence that shows that endoscopic or ESWL are equally safe and efficacious in those clinical scenarios. Familiarity with the full spectrum of endourological techniques facilitates a minimally invasive approach to pediatric ureteral stones.

Current management of paediatric urolithiasis

“…If ESWL is not promising, ureteroscopy can be used [35,36]. The increasing availability of smaller size endourological equipment has made it possible to manage paediatric ureteral stones using endoscopic techniques [37][38][39][40][41]. The technique used in children is similar to that used in adults.…”

“…Because of the smaller size of the probes, laser energy is easier to use in smaller instruments and is more useful for paediatric cases. All studies reporting the use of endoscopy for ureteric stones in children have clearly demonstrated that there is no significant risk of ureteric strictures or reflux with this mode of therapy [39][40][41].…”

The effect of extracorporeal shock wave lithotripsy on distribution of interstitialcells of Cajal in rabbit renal pelvis and proximal ureter

“…Some cases require more than 1 session of ESWL (up to 3 sessions) for a better stone-free rate (1,2,8,9). Each session consists of 1800 to 2000 shock waves (and up to 4000) between 14 and 21 kV (2,3).…”

“…The effectiveness of ESWL is measured by the stonefree rate, which has been reported from 50% to 95% in children (1)(2)(3)8). Some cases require more than 1 session of ESWL (up to 3 sessions) for a better stone-free rate (1,2,8,9).…”

Efficacy and Safety of Pediatric Ureteroscopy in the Treatment of Ureteric Calculi in Children

“…In the presence of a calculus in the ureter, the question to be answered is whether the stone will pass spontaneously or not. In general, the rate of spontaneous passage of a stone less than 4mm is related to its position in the ureter, 75% in the distal, 60% in the middle and 50% in the proximal ureter 14 . On the other hand, stones of 5mm-10mm have a spontaneous passage rate of 10 -50% depending on the position at which they are located.…”