The Investigation Of The Security And Efficacy Of Flexible Ureteroscopic Lithotripsy For Pediatrics With Renal And Upper Ureteral Calculi

Objective: To investigate the security and efficacy between flexible ureteroscope lithotripsy(f URSL) and minimally invasive percutaneous nephrolithotripsy(m PCNL) in the management of pediatric kidney and upper ureteral calculi,and to provide some guidance for a more appropriate management of kidney and upper ureteral calculi in pediatric population.Method: We conducted a retrospective review of all children with kidney and upper ureteral calculi who received f URSL or m PCNL in the First Affiliated Hospital of Zhengzhou University from June 2011 to December 2015.A total of 72 children were divided into two groups,f URSL and m PCNL.The group of f URSL included 27 children and 32 flexible ureteroscope lithotripsy procedures and the other group included 45 procedures. Information regarding patient age, sex,stone burden, operation time,bed time, postoperative hospital stay,surgical complications(based on Clavein system) and stone free rate was collected. SPSS version17.0 software was used for statistical analysis.Result: 1.In the two groups of f URSL and m PCNL, average age was 8.07 ±3.09 and 7.09 ±3.46, the stone size was 13.50±4.32 and 13.50±5.81,and male patients proportion was 59.26%(16/27) and 57.78%(26/45) respectively. 2.Average operation time was 80.00±16.08 min and 58.38±18.52 min.Median bed time was 1.88d(1.55~2.20)and 2.71d(2.37~3.05).Median postoperative hospital stay time was 4.00d(3.43~4.57)and 8.00d(8.01~9.23). 3.Stone free rate after a single procedure was 78.13% and 88.89%(χ2=1.65, p=0.20)and was 87.50% and 95.56%(χ2=1.69,p=0.19)after 3 months.3 months later, In m PCNL group,one patient received ESWL therapy,the other one underwent medical expulsive therapy(MET).In f URSL group,there were two patients received MET. 4.The total complication rate was 18.75%(6/32) and 22.22%(10/45) respectively.(χ2=0.14,p=0.71) 5.Ureteral access sheaths were used in all patients and total 32 procedures from f URSL group,the first success rate was 78.12%,5 of the failed ones were subsequently stented with 4.7Fr ureteral stent to allow for passive ureteral dilation for a period of 2 weeks.Another 2 children were performed active ureteral orifice dilation ureteral dilators.All of the 7 dilated ureters got successful insertion of UAS.Conclusion: 1.Both f URSL and m PCNL are effective and safe surgical options for children with kidney and upper ureteral calculi. 2.f URSL is more minimally invasive, shorter hospitalization and bed time and quick recovery. m PCNL is dominate in operation time. 3.Routine pre-stenting before f URSL is not essential,surgeons can use it in select cases based on the duration of the procedure.We may conclude that the use of ureteral access sheath is safe in a short period,and the complications including ureteral wall ischemic,necrosis and perforation are less likely.Because the follow-up time is short,the long-term complications such as ureterostenosis and ureteral occlusion can’t be evaluated.