Should ureteroscopy be considered as the first choice for proximal ureter stones of children?

OBJECTIVES: In this study, we aimed to analyze the ureter stones that had been treated using rigid ureteroscopy and pneumatic lithotripsy without mechanically dilating the ureteral orifice. PATIENTS AND METHODS: Records of 110 patients who had undergone rigid ureteroscopy and pneumatic lithotripsy due to ureteral stone between February 2005 and May 2011 were retrospectively analyzed. The location and size of the stone and additional anomalies in the urinary tract on the preoperative direct urinary system (DUS) X-Ray, urinary system ultrasonography (USG), intravenous pyelography (IVP) if performed, and computed tomography (CT), were found from the records of the patients. RESULTS: The mean age of the patients was 5.2 (range 1-17 years). 74 (67.2%) of the patients were males and 36 (32.8%) were females. A total of 115 rigid ureteroscopies were performed on 110 patients. 72 (65%) of the stones were located in the lower ureter, 21 (19%) were located in the middle part of the ureter, and 17 (15.4%) were located in the upper ureter. The mean stone size was determined as 7.5 mm (range 5-15). The mean stone size was determined as 7.4 mm in the lower ureter, as 8.3 mm in the middle ureter, and 8.4 mm in the upper ureter. No difference was found between the sizes of the stones in different locations (p = 0.121). The stone free rate was found as 92.2% for all ureteral stones. The total stone free rate according to the location of the stones was determined as 79.2% in the upper ureter, as 94.4% in the middle ureter and 93,8% in the lower ureter (p = 0.022). The total complication rate was 7.6%. Complication rates were 7.2%, 4.1% and 10.7% for the lower, middle and upper ureter, respectively (p = 0.411) (Table I). No difference was found in terms of complication rates according to location of the stone in the ureter. No major perioperative or postoperative complications developed. A double J stent was inserted in 36 (32%) patients for 2-3 weeks. CONCLUSIONS: We suggest that rigid ureteroscopy may be considered as the first choice for treatment of not only distal-middle ureter stones, but also for proximal ureter stones.

The effectiveness of extracorporeal shock wave lithotripsy in the treatment of ureteral stones in children.

PURPOSE: In our study, we evaluated retrospectively the efficacy of extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral stones in children. MATERIALS AND METHODS: Between the dates of 2005-2010, 62 children who were applied ESWL due to the ureteral stone in our Clinic and consisted of 42 males and 20 girls whose mean age was 6.6+/=3.1 were evaluated. 31 (50%) of the patients were upper ureteral stone, 10 (16.1%) of them were middle ureteral stone and 21 (33.9%) of them were lower ureteral stone. The sizes of the stones were 4 to 17 mm, the average was 7.1 mm. ESWL was performed in the supine position for upper ureteral stones, in the supine/prone position for middle and lower ureteral stones. RESULTS: Stone-free rate was determined as 93.5% in three-month follow-up of the patients. Re-treatment was done at 14.5% of the patients. The implementation of ESWL was ended unsuccessfully at 4 children (6.5%). A significant difference was not detected between three-month stone-free rates in terms of the size of the stones and location. There was not any serious complication at any of the patients. CONCLUSIONS: According to these findings ESWL with its high stone-free rates and negligible complications is the first method to be refered in the treatment of ureteral stones in children.