Lesani O Alex, Palmer Jeffrey S
Division of Pediatric Urology, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA.
J Urol. 2006 Oct;176(4 Pt 1):1570-3. doi: 10.1016/j.juro.2006.06.038.
Traditionally, rigid ureteroscopy in adults has been reserved for distal ureteral procedures, due to the risk of injury associated with proximal ureteroscopy. However, the safety of proximal rigid ureteroscopy in prepubertal children is not well established.
We retrospectively evaluated all prepubertal children (12 years old and younger) who underwent attempted rigid proximal ureteroscopy and pyeloscopy. The indications for ureteroscopy were treatment of ureteral and/or renal pelvic calculi, and evaluation of hematuria. All patients were evaluated postoperatively with renal and bladder ultrasonography and abdominal radiography (if stone was visible before treatment).
A total of 24 consecutive children 3.4 to 12 years old underwent 24 ureteropyeloscopic procedures. Of these children 20 (83%) successfully underwent 20 rigid ureteroscopic and pyeloscopic procedures. However, 4 procedures (17%) were converted from rigid to flexible endoscopy to perform 4 successful ureteropyeloscopies. The indications for ureteroscopy were treatment of ureteral and/or renal pelvic calculi in 22 patients and evaluation of hematuria in 2. Followup was 0.6 to 3.6 years (mean 1.9) for the patients undergoing rigid ureteropyeloscopy. All children with calculi were rendered stone-free based on direct visualization by complete ureteroscopy and pyeloscopy of the affected system. No complications occurred during any of the procedures.
Proximal rigid ureteroscopy and pyeloscopy can be safely applied toward treatment of proximal ureteral and renal pelvic calculi as well as diagnostic ureteropyeloscopy in prepubertal children. The technique has several advantages compared to flexible ureteroscopy.
传统上，由于近端输尿管镜检查存在受伤风险，成人的硬性输尿管镜检查一直仅限于输尿管远端手术。然而，青春期前儿童近端硬性输尿管镜检查的安全性尚未明确确立。
我们回顾性评估了所有尝试进行近端硬性输尿管镜检查和肾盂镜检查的青春期前儿童（12岁及以下）。输尿管镜检查的适应证为输尿管和/或肾盂结石的治疗以及血尿的评估。所有患者术后均接受肾脏和膀胱超声检查以及腹部X线摄影（如果治疗前结石可见）。
共有24名年龄在3.4至12岁的连续儿童接受了24次输尿管肾盂镜检查。在这些儿童中，20名（83%）成功进行了20次硬性输尿管镜检查和肾盂镜检查。然而，4次手术（17%）从硬性内镜转换为软性内镜，以成功进行4次输尿管肾盂镜检查。输尿管镜检查的适应证为22例患者的输尿管和/或肾盂结石治疗以及2例患者的血尿评估。接受硬性输尿管肾盂镜检查的患者随访时间为0.6至3.6年（平均1.9年）。所有结石患儿通过对受影响系统进行完整的输尿管镜检查和肾盂镜检查直接观察，结石均清除。所有手术过程中均未发生并发症。
近端硬性输尿管镜检查和肾盂镜检查可安全应用于青春期前儿童近端输尿管和肾盂结石的治疗以及诊断性输尿管肾盂镜检查。与软性输尿管镜检查相比，该技术具有多个优点。
