Skip to main content
SpringerLink
Log in

Ureteroscopy for Treatment of Upper Urinary Tract Stones in Children: Technical Considerations

  • Minimally Invasive Surgery (V Bird and M Desai, Section Editors)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

The incidence of pediatric urolithiasis is increasing. While many smaller stones may pass spontaneously, surgical therapy is sometimes warranted. Surgical options include shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, and open surgery. Ureteroscopy represents a minimally invasive approach, and it is increasingly being used to treat pediatric upper tract calculi. Ureteroscopy is performed under anesthesia and fluoroscopic guidance, with basket extraction or lithotripsy of the calculi. Technical considerations include active or passive ureteral dilatation, the use of ureteral access sheaths for larger stone burdens, and post-operative stent placement. The current pediatric literature suggests high success rates (equal to or surpassing shock wave lithotripsy) and low complication rates. However, concerns remain regarding feasibility in patients with variant anatomies and risk due to intra-operative radiation exposure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Sas DJ et al. Increasing incidence of kidney stones in children evaluated in the emergency department. J Pediatr. 2010;157(1):132–7.

    Article  PubMed  Google Scholar 

  2. Srivastava T, Alon US. Urolithiasis in adolescent children. Adolesc Med Clin. 2005;16(1):87–109.

    Article  PubMed  Google Scholar 

  3. Novak TE et al. Sex prevalence of pediatric kidney stone disease in the United States: an epidemiologic investigation. Urology. 2009;74(1):104–7.

    Article  PubMed  Google Scholar 

  4. Schissel BL, Johnson BK. Renal stones: evolving epidemiology and management. Pediatr Emerg Care. 2011;27(7):676–81.

    Article  PubMed  Google Scholar 

  5. Desai M. Endoscopic management of stones in children. Curr Opin Urol. 2005;15(2):107–12.

    Article  PubMed  Google Scholar 

  6. Smaldone MC et al. Is ureteroscopy first line treatment for pediatric stone disease? J Urol. 2007;178(5):2128–31. discussion 2131.

    Article  PubMed  Google Scholar 

  7. Pietrow PK et al. Clinical outcome of pediatric stone disease. J Urol. 2002;167(2 Pt 1):670–3.

    Article  PubMed  Google Scholar 

  8. Milliner DS, Murphy ME. Urolithiasis in pediatric patients. Mayo Clin Proc. 1993;68(3):241–8.

    Article  CAS  PubMed  Google Scholar 

  9. Perrone HC et al. Urolithiasis in childhood: metabolic evaluation. Pediatr Nephrol. 1992;6(1):54–6.

    Article  CAS  PubMed  Google Scholar 

  10. Alon US, Zimmerman H, Alon M. Evaluation and treatment of pediatric idiopathic urolithiasis—revisited. Pediatr Nephrol. 2004;19(5):516–20.

    Article  PubMed  Google Scholar 

  11. Langman CB et al. A position statement on kidney disease from powdered infant formula-based melamine exposure in Chinese infants. Pediatr Nephrol. 2009;24(7):1263–6.

    Article  PubMed  Google Scholar 

  12. Hulton SA. Evaluation of urinary tract calculi in children. Arch Dis Child. 2001;84(4):320–3.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. VanDervoort K et al. Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome. J Urol. 2007;177(6):2300–5.

    Article  PubMed  Google Scholar 

  14. Palmer JS et al. Diagnosis of pediatric urolithiasis: role of ultrasound and computerized tomography. J Urol. 2005;174(4 Pt 1):1413–6.

    Article  PubMed  Google Scholar 

  15. Johnson EK et al. Are stone protocol computed tomography scans mandatory for children with suspected urinary calculi? Urology. 2011;78(3):662–6. This manuscript demonstrated that computed tomography is not always necessary in the evaluation of pediatric urolithiasis and that renal sonography is an adequate initial assessment that avoids radiation exposure.

    Article  PubMed  Google Scholar 

  16. Van Savage JG et al. Treatment of distal ureteral stones in children: similarities to the american urological association guidelines in adults. J Urol. 2000;164(3 Pt 2):1089–93.

    Article  PubMed  Google Scholar 

  17. Aydogdu O et al. Effectiveness of doxazosin in treatment of distal ureteral stones in children. J Urol. 2009;182(6):2880–4.

    Article  CAS  PubMed  Google Scholar 

  18. Mokhless I et al. Tamsulosin for the management of distal ureteral stones in children: a prospective randomized study. J Pediatr Urol. 2012;8(5):544–8.

    Article  PubMed  Google Scholar 

  19. Edvardsson V et al. High incidence of kidney stones in Icelandic children. Pediatr Nephrol. 2005;20(7):940–4.

    Article  PubMed  Google Scholar 

  20. Casale P et al. Transperitoneal laparoscopic pyelolithotomy after failed percutaneous access in the pediatric patient. J Urol. 2004;172(2):680–3. discussion 683.

    Article  PubMed  Google Scholar 

  21. Lee RS et al. Early results of robot assisted laparoscopic lithotomy in adolescents. J Urol. 2007;177(6):2306–9. discussion 2309-10.

    Article  PubMed  Google Scholar 

  22. Ost MC, Schneck FX. Surgical management of pediatric stone disease. In: Wein AJ et al., editors. Campbell-Walsh urology. 10th ed. Philadelphia: Elsevier; 2012. p. 3667–84.

    Chapter  Google Scholar 

  23. Newman DM et al. Extracorporeal shock wave lithotripsy experience in children. J Urol. 1986;136(1 Pt 2):238–40.

    CAS  PubMed  Google Scholar 

  24. Wu HY, Docimo SG. Surgical management of children with urolithiasis. Urol Clin N Am. 2004;31(3):589–94. xi.

    Article  Google Scholar 

  25. Galal EM, Fath El-Bab TK, Abdelhamid AM. Outcome of ureteroscopy for treatment of pediatric ureteral stones. J Pediatr Urol. 2013;9(4):476–8. This recent manuscript examined outcomes of pediatric ureteroscopy for ureteral stones and helped estabilsh the safety of ureteroscopy in the pediatric population.

    Article  PubMed  Google Scholar 

  26. El-Assmy A et al. Safety and outcome of rigid ureteroscopy for management of ureteral calculi in children. J Endourol. 2006;20(4):252–5.

    Article  PubMed  Google Scholar 

  27. Schuster TG et al. Ureteroscopy for the treatment of urolithiasis in children. J Urol. 2002;167(4):1813. discussion 1815-6.

    Article  PubMed  Google Scholar 

  28. Abhishek KJ, et al. Pediatric urolithiasis: experience from a tertiary referral center. J Pediatr Urol. 2013. This recent manuscript also examined outcomes of pediatric ureteroscopy for ureteral stones and helped estabilsh the safety of ureteroscopy in the pediatric population.

  29. Vanlangendonck R, Landman J. Ureteral access strategies: pro-access sheath. Urol Clin N Am. 2004;31(1):71–81.

    Article  Google Scholar 

  30. Abrahams HM, Stoller ML. The argument against the routine use of ureteral access sheaths. Urol Clin N Am. 2004;31(1):83–7.

    Article  Google Scholar 

  31. Delvecchio FC et al. Assessment of stricture formation with the ureteral access sheath. Urology. 2003;61(3):518–22. discussion 522.

    Article  PubMed  Google Scholar 

  32. De Dominicis M et al. Retrograde ureteroscopy for distal ureteric stone removal in children. BJU Int. 2005;95(7):1049–52.

    Article  PubMed  Google Scholar 

  33. Smaldone MC et al. Endourological management of pediatric stone disease: present status. J Urol. 2009;181(1):17–28.

    Article  PubMed  Google Scholar 

  34. Colangelo CJ et al. Ureteroscopy in pediatric patients with spinal abnormalities. J Endourol. 2013;27(5):545–8.

    Article  PubMed  Google Scholar 

  35. Krambeck AE et al. Management of nephrolithiasis after Cohen cross-trigonal and Glenn-Anderson advancement ureteroneocystostomy. J Urol. 2007;177(1):174–8.

    Article  PubMed  Google Scholar 

  36. Kokorowski PJ et al. Prospective measurement of patient exposure to radiation during pediatric ureteroscopy. J Urol. 2012;187(4):1408–14. This manuscript elegantly examined the radiation exposure risks to pediatric patients undergoing ureteroscopy for renal stones and identified technical changes that could reduce radiation exposure.

    Article  PubMed  Google Scholar 

  37. Taylor ER et al. Ocular radiation exposure in modern urological practice. J Urol. 2013;190(1):139–43.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Natasha Gupta, Dr. Joan Ko, Dr. Brian R. Matlaga, and Dr. Ming-Hsien Wang each declare no potential conflicts of interest relevant to this article.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. The Johns Hopkins University School of Medicine, 733 North Broadway Street, Baltimore, MD, 21205, USA

    Natasha Gupta

  2. Division of Pediatric Urology, The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA

    Ming-Hsien Wang

  3. The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA

    Joan Ko & Brian R. Matlaga

Authors
  1. Natasha Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joan Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brian R. Matlaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ming-Hsien Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ming-Hsien Wang.

Additional information

Natasha Gupta and Joan Ko contributed equally to this manuscript.

This article is part of the Topical Collection on Minimally Invasive Surgery

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gupta, N., Ko, J., Matlaga, B.R. et al. Ureteroscopy for Treatment of Upper Urinary Tract Stones in Children: Technical Considerations. Curr Urol Rep 15, 407 (2014). https://doi.org/10.1007/s11934-014-0407-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-014-0407-4

Keywords

Search

Navigation