Ureteroscopy is safe and effective in prepubertal children

Purpose: We present our experience performing ureteroscopy in prepubertal children. Materials and Methods: We performed a retrospective cohort study of children 12 years or younger who underwent ureteroscopy at 2 institutions between 1993 and 2003. Patient demographics, indications for surgery, operative technique, surgical outcomes and complications were recorded. Results: A total of 39 boys and 32 girls underwent 34 flexible and 47 rigid ureteroscopies. Retrograde access was obtained in 77 procedures, while 4 were performed via an antegrade approach. Mean age was 7.5 years (range 1 to 12) and mean followup was 2.2 years (0.5 to 10). Endoscopic lithotripsy was performed in 65 cases, with a success rate of 98%. A ureteral stent was placed postoperatively in 55 patients. Endoscopic incision was performed for a ureteral stricture in 3 patients and for ureteropelvic junction obstruction in 6. An obstructing fibroepithelial polyp was found in 2 patients, 1 underwent removal of a foreign body and 4 did not have intraluminal pathology. Dilation of the ureteral orifice was required in 23 cases (30%). There were no intraoperative ureteral injuries. One patient had development of a ureteral stricture (complication rate 1.3%) that was successfully treated endoscopically. Conclusions: Rigid and flexible ureteroscopy can be performed safely and effectively in prepubertal children. Successful outcomes can be obtained for calculi that are similar to those in the adult population. Ureteroscopic treatment can be effective in selected children with intraluminal obstruction. To our knowledge this is the largest series in the literature to document outcomes of ureteroscopy in this age group.