Ureteral Stones in Children; What Has Changed With the Increase in Experience?
Condition: Ureter Stone; Childhood
MeSH terms: Ureteral Calculi; Ureterolithiasis; Calculi
Study type: Observational

Summary: 
      With advances in endourological equipment, minimally invasive procedures have been found to
      be sufficient for the treatment of ureteral stones in children. The investigators aimed to
      evaluate the stone-free rate and complications related to the procedure and to compare it
      with the period when their experience were limited by presenting their patients with ureteral
      stones treated by ureteroscopy (URS) and holmium YAG laser in the last three years after
      their 15-year routine endourological practice.

      The investigators retrospectively compared 54 cases treated with ureteroscopy (URS) for
      ureteral stones between 2009-2011, the first three years of our endourological interventions
      in children, and 78 cases treated with URS for ureteral stones between 2020-2022, the last
      three years of their 15-year endourological experience, from hospital records. Demographic
      data, stone-free rates, number of procedures and recorded complications were evaluated in
      both groups.
    

Detailed description: 
      Due to the changing diet habits and sedentary lifestyle, the investigators encountered
      urinary system stones more and more frequently in children. Ureteral stones in children are
      now routinely treated with endourological interventions with the introduction of thin
      ureteroscopes. Despite the developing endoscopy technology, the smaller ureter diameter in
      children than in adults requires more careful and meticulous intervention technically. The
      investigators have published that in their first 54 cases in which they started to use
      routine endourological methods in the treatment of ureteral stones in pediatric patients
      between 2009 and 2011, the investigators had a stone-free rate of 57%, a complication rate of
      9.7%, and a conversion rate of 18.75% to open surgery in the first attempt. In the
      literature, it is seen that different results are given in terms of stone-free and
      complications after ureteroscopy treatment for ureteral stones in children. The investigators
      aimed to evaluate the stone-free rate and complications related to the procedure and compare
      it with the period when our experience was limited by presenting their patients with ureteral
      stones that the investigators treated with ureteroscopy and Holmium YAG laser in the last
      three years, following their 15-year-old endourological routine practice experience.

      Between 01 01 2020 and 31 12 2022, 78 children with ureteral stones who were operated on in
      their clinic were retrospectively evaluated from the hospital records. A total of 40 males
      and 38 females with a mean age of 9,64+4,91 years (range 0.75 to 17) required surgical
      treatment for ureteral stones. USG or computerized tomography was performed in all cases, and
      mean stone size was 6.58+2.94 mm. (range 3,5 to 20). When stones did not pass spontaneously,
      the patients were treated with ureteroscopic laser lithotripsy.

      All ureteroscopic procedures were performed under general anesthesia. An initial cystoscopy
      was done with a 8 Fr Storz cystoscope. A working guide wire was placed and negotiated beyond
      the level of the stone. A 4,5 Fr semirigid ureteroscope was used in all cases. Calculi were
      fragmented using holmium YAG laser. Fragments were extracted using a stone basket or grasper.
      The decision to place an ureteric stent postoperatively was based on the degree of ureteral
      trauma. The extracted stone fragments were sent for chemical analysis and further medical
      treatment initiated when appropriate. In children in whom ureteroscopy was not possible due
      to inability to introduce the ureteroscope, an ureteric stent was placed for passive dilation
      and ureteroscopy repeated 3 week later. All ureteroscopic procedures were carried out under
      antibiotic cover. All children underwent routine ultrasonography and urine examination in the
      follow-up period.

      Stone-free status was determined both endoscopically at the end of the procedure and
      radiologically (USG) at 3 months follow-up prior to outpatient review. Stone-free rate (SFR)
      was defined as fragments confrmed radiologically and at least 6 months passed since the
      previous operation.
    

Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Between 01 01 2020 and 31 12 2022, 78 children with ureteral stones who were operated on in
        our clinic were retrospectively evaluated from the hospital records. A total of 40 males
        and 38 females with a mean age of 9,64+4,91 years (range 0.75 to 17) required surgical
        treatment for ureteral stones.
      
Keywords: Ureter Stone; Children; Complication; Stone Free Rate