Upper Third Ureteric Calculi in Preschool Age Children: Preliminary Experience with Flexible Ureteroscopy and Holmium Laser Lithotripsy

Aims: to evaluate the efficacy and safety of flexible ureteroscopy with holmium laser for the treatment of preschool age children ≤ 6 years with upper third ureteric stones.

Patients and Methods: Nine preschool children with a male/female ratio of 4/5 (mean age 3.6 years; range 2–6 years) with upper third ureteric stones < 2 cm who were treated with flexible ureteroscopy (FURS) and LASER lithotripsy between October 2020 to October 2022 in the department of urology, Faculty of Medicine Tanta University were studied. Ultrasonography, plain abdominal radiograph film, and low-dose non-contrast computerized tomography (NCCT) were obtained from all patients. Pre-operative ureteric stent was applied in all patients 2 weeks prior to their undergoing ureteroscopy as a routine. Patient demographics, stone size, post operative stenting, use of ureteral access sheath, stone-free rate, operative time, complication rates, and follow-up were evaluated. Low-dose non-contrast computed tomography (CT) was performed one month postoperatively to all children and they were considered stone-free if there were no residual fragments < 2 mm postoperatively.

Results: Nine preschool patients (4 boys and 5 girls) who were children, with a mean age of 3.6 years (whose ages had ranged from 2 years to 6 years old), underwent FURS and holmium laser lithotripsy. The mean stone size was 11.1 mm (8 mm -16mm). Preoperative ureteric stenting was routine in all patients. The mean operative time was 55.1 minutes (range 36-78 minutes). Ureteral access sheaths were placed in 7 (77.77%) patients. The success rate for the first month was 88.88%. No major complications were reported e.g., ureteral perforation and/or mucosa avulsion. Minor complications occurred in 1 patient (11.1%).

Conclusion: The management of upper third ureteric stones < 2cm in pediatric preschool population using flexible ureteroscopy is a safe and effective option.