Safety and efficacy of pediatric ureteroscopy for management of calculous disease.

Ureteral calculi, although relatively uncommon in children in the United States, have traditionally been managed with open surgical removal. Innovations in managing ureteral stones in the adult population have not readily been used to manage such problems in children due to unknown effects on the ureterovesical junction and to the unavailability of smaller caliber ureteroscopes. We report on the technique and long-term (average 26 months, range 3 to 56) safety following 18 successful ureteroscopic procedures for stone removal in 16 patients 16 months to 15 years old. All children were rendered stone-free. Followup quantitative renal scans and excretory urography showed adequate renal growth. No incidence of vesicoureteral reflux occurred in 9 of the 14 patients (64%) available for followup who underwent postoperative cystograms. These results suggest that judicious use of smaller caliber instruments, improved ancillary equipment and experience in such procedures make ureteroscopy a safe procedure for management of ureteral calculi in children.