Operative TechniqueMicro-ureteroscopy for the treatment of distal ureteral calculi in children

ObjectiveThe objective of this study was to demonstrate the efficacy and safety of micro-ureteroscopy (micro-URS) in the management of distal ureteral stones in the pediatric population.Materials and MethodsA total of 11 children, who had undergone micro-URS between September 2015 and April 2016 with the indication of distal ureteral calculi in two referral centers, were retrospectively evaluated. The procedures were performed with the patient in the lithotomy position under general anesthesia using the standard URS technique with a micro-ureteroscope that has a caliber of 4.85 Fr all along its length. Demographics, perioperative data, and outcomes were assessed.ResultsRight (n = 6) and left (n = 8) ureteral stones were detected in the respective number of patients. The mean age of the children was calculated as 55.1 months (range, 6-161 months). The median stone size was 10.5 mm (range, 6-24 mm). The median operative time was 36.8 min (range, 23-68 min). A double 3 stent was implanted in 3 of 11 patients because of severe edema. As a postoperative complication mild hematuria (Clavien grade 1) was observed in one case and resolved spontaneously. Intraoperative minor or major complication did not occur in any of the cases. The mean hospitalization time was determined as 21.4 h (range, 10-28 h). Stone-free status was accomplished in all patients in the final assessment.ConclusionThe outcomes of our series show that micro-URS can be used safely and effectively in the treatment of pediatric distal ureteral stones. Further prospective and comparative studies comparing instruments of different size are warranted.