Retrograde intrarenal lithotripsy for small renal stones in prepubertal children

Abstract

Advancements in ureteroscopy have now given the urologist virtually unrestricted access to calculi at all locations in the upper urinary tract. Retrograde intrarenal lithotripsy is a new modality to treat upper urinary tract stones in children. In this retrospective study, we present our experience in retrograde intra-renal lithotripsy in children over a period of 30 months. Fifty-six children with renal stones less than 1.5 cm in size, who underwent retrograde intrarenal lithotripsy during the period from January 2007 to June 2009 at Prince Hussein Urology Center, Royal Medical Center, Amman, Jordan, were included in the study. The average age was 8.2 years and male to female ratio was 2.1:1. The average size of the stone was 1.2 cm, ranging from 0.9 to 1.5 cm. Twelve patients (15.5%) had bilateral stones. All patients had a Double J stent inserted 2-4 weeks prior to the procedure. Ureteroscopy up to the renal pelvis was performed and fragmentation of the pelvic stones was performed by electrohydraulic lithotriptor and the patients were on follow-up during this period. Overall, a total of 78 procedures were performed in these patients. Twelve patients underwent bilateral procedures for bilateral disease, but in separate settings. Nine patients (16%) needed a second session for residual stones. Only four patients (7.1%) needed a third session. The clearance rate was 94.8%. Three patients (3.9%) developed upper urinary tract infection after ureteroscopy; one patient (1.7%) developed frank hematuria postoperatively that was treated conservatively. No residual stones or other complications were detected during an average of 34 months of follow-up. Thus, in the expanding field of pediatric urolithiasis, retrograde intrarenal lithotripsy seems promising and is less invasive and has fewer complications.