Ureteroscopy With Holmium:Yag Laser Lithotripsy for Ureteral Stones in Preschool Children: Analysis of the Factors Affecting the Complications and Success.

Objective: To evaluate the factors that may affect the efficacy and safety of ureteroscopy with holmium:YAG laser lithotripsy in the management of ureteral stones in preschool children.

Materials And Methods: Medical records of 70 children, 32 boys and 38 girls, who were treated for ureteral stones at our clinic between 2014 and 2016 were retrospectively reviewed. Patients were grouped according to size of the instrument used as group 1 (n = 40, ultrathin 4.5 Fr) and group 2 (n = 30, 7.5 Fr). Patient age, stone characteristics, and operative and postoperative outcomes were compared. The effect of age, stone size and location, type of the instrument, and operative times on success and complication rates were also investigated. In addition, factors related with postoperative hydronephrosis were evaluated.

Results: Patients in group 1 were significantly younger than group 2 (32.22 ± 22.72 vs 63.53 ± 16.98 months, P = .000). Groups were similar in terms of gender, stone laterality, size and location, and operative times. However, access failure rate was significantly higher in group 2 (0 vs 20%, P = .022). Stone-free rate was 87.5% in group 1 and 76.6% in group 2 (P = .237), complication rates were not significantly different among groups. Stone size and location were found to be associated with success rates. Stone location and operative times were the factors affecting the complication rates. Presence of preoperative hydronephrosis and prolonged operative time were determined as the predictors of postoperative hydronephrosis.

Conclusion: Ultrathin ureteroscopy with laser lithotripsy can be used safely and effectively for ureteral calculi including proximal ones in significantly younger children without any access failure.