Juliebø-Jones Patrick, Æsøy Mathias Sørstrand, Gjengstø Peder, Beisland Christian, Ulvik Øyvind
Department of Urology, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway.
Department of Urology, Haukeland University Hospital, Bergen, Norway.
Ther Adv Urol. 2022 Aug 22;14:17562872221118727. doi: 10.1177/17562872221118727. eCollection 2022 Jan-Dec.
Paediatric stone disease is rare in the Nordic communities. Still, the condition can require surgical intervention in the form of ureteroscopy (URS). Here, we report outcomes achieved at a regional (tertiary) centre.
Retrospective analysis was performed of consecutive patients (<18 years of age) undergoing URS for stone disease between 2010 and 2021. Outcomes of interest included stone-free rate (SFR) determined using a definition of no residual fragments ⩾ 3 mm on imaging and complications classified according to Clavien-Dindo system.
In total, 23 patients underwent 47 URS procedures for a total of 31 stone episodes. Mean age was 9 (range 1-17) years and male-to-female ratio was 6:17. Overall, 35% had at least one medical comorbidity. Ultrasound determined preoperative stone status in 87%. Mean largest index and cumulative stone sizes were 9 (range 3-40) and 12 (range 3-40) mm, respectively. Overall, 32% had multiple stones. Lower pole was the commonest stone location (39%). No patients underwent elective pre-operative stenting. Ureteral access sheaths were not used in any cases. Access to upper urinary tract at first procedure was successful in 94%. Initial and final SFR was 61% and 90%, respectively. No intra-operative complications were recorded. Overall post-operative complication rate was 17.5%. Urinary tract infection (CD II) was the commonest adverse event (12.5%).
Paediatric URS can be delivered in the setting of a regional centre without compromising outcomes. This includes when carried out by adult endourologists, without routine pre-stenting and omitting use of ureteric access sheath.
小儿结石病在北欧社区较为罕见。然而，这种情况可能需要通过输尿管镜检查（URS）进行手术干预。在此，我们报告一家区域（三级）中心取得的治疗结果。
对2010年至2021年间因结石病接受URS治疗的连续患者（<18岁）进行回顾性分析。关注的结果包括根据影像学定义无残留碎片≥3 mm确定的结石清除率（SFR）以及根据Clavien-Dindo系统分类的并发症。
共有23例患者接受了47次URS手术，共计31次结石发作。平均年龄为9岁（范围1 - 17岁），男女比例为6:17。总体而言，35%的患者至少有一种内科合并症。87%的患者通过超声确定术前结石情况。平均最大结石径线和累积结石大小分别为9 mm（范围3 - 40 mm）和12 mm（范围3 - 40 mm）。总体而言，32%的患者有多发性结石。下极是最常见的结石部位（39%）。没有患者接受选择性术前支架置入。所有病例均未使用输尿管接入鞘。首次手术时对上尿路的穿刺成功率为94%。初始和最终结石清除率分别为61%和90%。未记录术中并发症。总体术后并发症发生率为17.5%。尿路感染（Clavien-Dindo II级）是最常见的不良事件（12.5%）。
在区域中心环境下进行小儿URS手术不会影响治疗效果。这包括由成人泌尿外科医生进行手术，无需常规术前支架置入且不使用输尿管接入鞘。
