Morrison Jeffrey C, Van Batavia Jason P, Darge Kassa, Long Christopher J, Shukla Aseem R, Srinivasan Arun K
Division of Urology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA.
Division of Urology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA.
J Pediatr Urol. 2018 Feb;14(1):64.e1-64.e6. doi: 10.1016/j.jpurol.2017.08.019. Epub 2017 Oct 14.
Ureteroscopy has been shown to be a highly efficacious and safe modality for the treatment of pediatric urolithiasis. However, conventional ureteroscopy relies on fluoroscopy for intraoperative guidance, exposing both patient and operating room personnel to ionizing radiation. Pediatric urolithiasis patients are at a particularly increased risk from this radiation exposure. The use of ultrasound in place of fluoroscopy for intraoperative guidance has emerged as one modification that can reduce radiation exposure during ureteroscopy. Although ultrasound-guided ureteroscopy has been shown to be a safe, and effective approach to stone management in adults, there have been no studies to date utilizing this approach in children.
The aim was to describe our initial experience with ultrasound-guided ureteroscopy in children as a safe and feasible modality to manage pediatric urolithiasis.
A retrospective review of consecutive patients that underwent ultrasound-guided ureteroscopy by one pediatric urologist (A.K.S.) from 2014 to 2016 for symptomatic urolithiasis was performed. Patient data were extracted from our center's IRB-approved prospectively maintained database of all children with urolithiasis.
Real-time ultrasonic guidance was provided by a pediatric uroradiology attending, with fluoroscopy available on standby. With the probe positioned on the patient's flank, ultrasound was used to visualize advancement of guidewire, dual-lumen catheter, and ureteroscope through the ureteral orifice and up to the renal pelvis (Figure). Stones were identified and removed via basket retrieval. At the conclusion of each case, ultrasonography was then used to confirm stent placement of indwelling double pigtail ureteral catheters.
Eleven patients were identified that underwent 12 ultrasound-guided ureteroscopic procedures in an outpatient setting. Stones were accessed in various locations and were removed by basket retrieval. Laser calycostomy into calyceal diverticulum and balloon dilations of ureterovesical junction and calyceal infundibulum were also performed. There were Clavien grade I and II complications in four patients; all of which were related to pain control.
To our knowledge, this is the first study reporting the successful use of ultrasound-guided ureteroscopy in children. The main limitation of this feasibility study is its small sample size. A larger series is needed to corroborate these findings and make them generalizable to a wider population.
This feasibility study accomplished its aim of demonstrating for the first time that ultrasound-guided ureteroscopy can be safely used in children to manage urolithiasis.
输尿管镜检查已被证明是治疗小儿尿路结石的一种高效且安全的方式。然而，传统输尿管镜检查术中依靠荧光透视进行引导，这会使患者和手术室人员都暴露于电离辐射中。小儿尿路结石患者受这种辐射暴露的风险尤其高。使用超声替代荧光透视进行术中引导已成为一种可减少输尿管镜检查期间辐射暴露的改进方法。尽管超声引导下输尿管镜检查已被证明是治疗成人结石的一种安全有效的方法，但迄今为止尚无在儿童中使用这种方法的研究。
目的是描述我们在儿童中进行超声引导下输尿管镜检查作为治疗小儿尿路结石的一种安全可行方式的初步经验。
对2014年至2016年由一位小儿泌尿科医生（A.K.S.）为有症状尿路结石进行超声引导下输尿管镜检查的连续患者进行回顾性研究。患者数据从我们中心经机构审查委员会批准的前瞻性维护的所有小儿尿路结石患者数据库中提取。
由一位小儿泌尿放射科主治医师提供实时超声引导，荧光透视备用。将探头置于患者侧腹，使用超声观察导丝、双腔导管和输尿管镜通过输尿管口直至肾盂的推进情况（图）。通过网篮取出识别并移除结石。在每个病例结束时，然后使用超声检查确认留置双猪尾输尿管导管的支架放置情况。
确定了11例患者，他们在门诊环境中接受了12次超声引导下输尿管镜检查手术。结石位于不同位置并通过网篮取出。还对肾盏憩室进行了激光肾盏造瘘术以及输尿管膀胱连接部和肾盏漏斗部的球囊扩张术。4例患者出现Clavien I级和II级并发症；所有这些均与疼痛控制有关。
据我们所知，这是第一项报道在儿童中成功使用超声引导下输尿管镜检查的研究。这项可行性研究的主要局限性在于其样本量小。需要更大规模的系列研究来证实这些发现并使其适用于更广泛的人群。
这项可行性研究实现了其首次证明超声引导下输尿管镜检查可安全用于儿童治疗尿路结石的目的。
