FACTORS AFFECTING THE OUTCOME OF URETEROSCOPY IN THE MANAGEMENT OF URETERAL STONES IN CHILDREN: A SINGLE CENTER EXPERIENCE

Abstract

Background:
 The urinary stone disease occurs in children with less incidence than the adult. Small urinary anatomy requires
fine instruments. The miniaturized devices, ureteroscopes and laser lithotripters are becoming popular in managing
pediatric ureteric stones with minimum complication. However, some factors are still there for identifying the
successful outcome of management.
Objective:
 To identify the factors affecting endoscopic pediatric ureteric stone management outcomes.
Patient Methods:
 This is a retrospective observational study during the period from June 2019 to March 2021. Including children at
the age of 12 and below. We reviewed our experience with indicated Ureteroscopy(URS) stone surgery performed
for 33children, including the history, physical examination, investigations, recorded data about the operative
findings, complications, postoperative recovery, and stone clearance. In addition, types of Ureteroscopy and
auxiliary instruments used were reviewed.
Results:
A-33 children, age range (2-12years) with an average of 6.1, had ureteroscopy surgery for ureteric stone,size of(5–
15 mm), with a mean of 8.05 mm. After a single session, stone-free was detected in 32 (97%) of the children.
Success rate was present in 32 cases (97%). Failure rate related to access failure occurred in 4 patients (12.2%), it
reduced to one patient(3%) when 6Fr URS used andwas significantly associated with age below three years and
small size ureters. Overall complication occurred in 25 cases (75.75%) . According to ( ClaveinDendo grading
system), postoperative complications were Grade I(75%) and Grade II(25%). there was no migration of stone or
extravasations. The mucosal injury occurred in 21.2%. Complete stone fragmentation was achieved in all patients.
Conclusions:
 Failure and complications rate in ureteroscopy and laser surgery was significantly affected by age below three
years and small ureters, and there was no relation to stone radiolucency or degree of hydronephrosis.