Endoscopic treatment of ureteral stones in children: efficacy, safety, and analysis of infectious-inflammatory complications
Kalit so‘zlar:
pediatric urolithiasis, ureteral calculi, ureteroscopy, children, postoperative complicationsAbstrak
Endoscopic techniques are increasingly used for ureteral stones in children, but data on their safety and on the determinants of postoperative infectious-inflammatory complications (IIC) in the pediatric population remain limited. This study aimed to evaluate the efficacy and safety of endoscopic treatment of ureteral stones in children and to analyze the frequency, severity, and correlates of IIC. We analyzed 85 children (aged 4–17 years) who underwent endoscopic treatment of ureteral stones at a single tertiary urology center; the pediatric cohort was assessed separately from adults because of anatomical and physiological differences, and demographic, stone-related, infection-related, and procedural variables were compared between children with and without IIC using univariate methods, with no multivariable modeling undertaken given the small number of complicated cases. The immediate stone-free rate was 98.8% (84/85), with a single residual stone that did not require reintervention; most stones were small (≤ 5 mm in 90.6%) and located in the distal ureter (54.1%), and treatment was delivered mainly by transurethral (retrograde) ureterolithotripsy (55.3%) and percutaneous antegrade ureterolithotripsy (43.5%). IIC occurred in 12 of 85 children (14.1%) and were mild in every case, with no acute obstructive pyelonephritis or urosepsis; on univariate comparison, the only variable that differed significantly between children with and without IIC was the degree of leukocyturia (median 151,250 vs 22,500/mL; p < 0.001), whereas sex, age, stone location and size, bacteriuria, blood leukocyte count, preoperative drainage, and type of intervention did not differ significantly. Endoscopic treatment of ureteral stones in children is thus highly effective and safe, achieving a very high stone-free rate with infrequent and uniformly mild infectious complications, and the baseline infectious status of the urinary tract, reflected chiefly by leukocyturia, is the principal correlate of IIC, underscoring the importance of preoperative assessment and correction of urinary infection.
##plugins.themes.default.displayStats.downloads##
Havolalar
1. Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y. Epidemiology of stone disease across the world. World J Urol. 2017;35(9):1301–1320.
2. Skolarikos A, Geraghty R, Somani B, Tailly T, Jung H, Neisius A, et al. European Association of Urology Guidelines on the Diagnosis and Treatment of Urolithiasis. Eur Urol. 2025;88(1):64–75.
3. Sultan S, Umer SA, Ahmed B, Naqvi SAA, Rizvi SAH. Update on surgical management of pediatric urolithiasis. Front Pediatr. 2019;7:252.
4. Güzel R, Yildirim Ü, Sarica K. Contemporary minimal invasive surgical management of stones in children. Asian J Urol. 2023;10(3):239–245.
5. Peng T, Zhong H, Hu B, Zhao S. Minimally invasive surgery for pediatric renal and ureteric stones: a therapeutic update. Front Pediatr. 2022;10:902573.
6. Zhu J, Phillips TM, Mathews RI. Operative management of pediatric urolithiasis. Indian J Urol. 2010;26(4):536–543.
7. Rob S, Jones P, Pietropaolo A, Griffin S, Somani BK. Ureteroscopy for stone disease in the paediatric population is safe and effective in medium- and high-volume centres: evidence from a systematic review. Curr Urol Rep. 2017;18(12):92.
8. Whatley A, Jones P, Aboumarzouk O, Somani BK. Safety and efficacy of ureteroscopy and stone fragmentation for pediatric renal stones: a systematic review. Transl Androl Urol. 2019;8(Suppl 4):S442–S447.
9. Chugh S, Pietropaolo A, Montanari E, Sarica K, Somani BK. Predictors of urinary infections and urosepsis after ureteroscopy for stone disease: a systematic review from the EAU Section of Urolithiasis (EULIS). Curr Urol Rep. 2020;21(4):16.
10. Sun JX, Xu J, Ouyang J. Risk factors of infectious complications following ureteroscopy: a systematic review and meta-analysis. Urol Int. 2020;104(3–4):113–124.
11. Bonkat G, Bartoletti R, Bruyère F, Cai T, Geerlings SE, Köves B, et al. EAU Guidelines on Urological Infections. European Association of Urology; 2024.
12. Ishii H, Griffin S, Somani BK. Flexible ureteroscopy and lasertripsy (FURSL) for paediatric renal calculi: results from a systematic review. J Pediatr Urol. 2014;10(6):1020–1025.
13. Guler AG, Karakaya AE, Dogan AB, Kandur Y. Our results for rigid ureteroscopy and laser lithotripsy in the pediatric age group. J Kırıkkale Univ Fac Med. 2021;23(2):338–342.
14. Dogan HS, Tekgul S, Akdogan B, Keskin MS, Sahin A. Use of the holmium:YAG laser for ureterolithotripsy in children. BJU Int. 2004;94(1):131–133.
15. Mahmoud H, Mohamed A, Abd-Elgawad A, Tawfiek E. Semi-rigid ureteroscopy in children using pneumatic lithotripsy: safety and efficacy. Minia J Med Res. 2020;31(3):400–406.
16. Kızılay F, Kalemci S, Turna B, Şimşir A, Nazlı O. Ho:YAG laser versus pneumatic lithotripsy for management of pediatric ureteral stones: a prospective comparative analysis with adults. J Pediatr Urol. 2020;16(1):35.e1–35.e7.
17. Jhanwar A, Bansal A, Sankhwar S, Kumar M, Kanodia G, Prakash G. Outcome analysis of holmium laser and pneumatic lithotripsy in the endoscopic management of lower ureteric calculus in pediatric patients: a prospective study. Int Braz J Urol. 2016;42(6):1178–1182.
18. Chunlin Y, Wanlin D, Jinhua D, Lucarelli G. Analysis of the efficacy of holmium laser and pneumatic ballistic lithotripsy in the treatment of impacted ureteral calculi. Medicine (Baltimore). 2020;99(36):e21805.
19. Pearle MS, Lingeman JE, Leveillee R, Kuo R, Preminger GM, Nadler RB, et al. Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less. J Urol. 2008;179(5 Suppl):S69–S73.
20. Kazan O, Cakici MC, Keser F, Culpan M, Efiloglu O, Yildirim A, et al. The role of preoperative urinalysis in predicting postoperative infection after retrograde intrarenal surgery in patients with sterile urine culture. Turk J Urol. 2022;48(2):136–141.
21. Calcagnile T, Sighinolfi MC, Rocco B, Assumma S, Di Bari S, Panio E, et al. Asymptomatic bacteriuria in candidates for active treatment of renal stones: results from an international multicentric study on more than 2600 patients. Urolithiasis. 2023;51(1):16.
