Pediatric Ureteroscopy

Endoscopic management of upper tract calculi has been demonstrated to be safe and effective in patients younger than 6 months up through adulthood. AUA guidelines suggest that ureteroscopy should be considered as first-line treatment for all upper tract calculi <20 mm in size in children due to higher stone-free rates and non-inferior complication rates relative to ESWL. The unique size and anatomic considerations of pediatric patients had in the past presented a barrier to retrograde endoscopic access to the upper tracts; however, advances in technology to miniaturize optics, scopes, and working accessories have allowed the modern urologist to overcome these barriers. Lower ureteral calculi are often addressed with semirigid ureteroscopy, and numerous options are available such that the urologist can select an age-appropriate scope for the procedure. Upper ureteral and renal calculi are addressed with flexible ureteroscopes which are able to deflect to the most difficult to reach lower pole stones, and access is facilitated with the help of ureteral access sheaths to protect the ureter from multiple passes of the ureteroscope. Stone fragmentation is achieved with Holmium:YAG laser lithotripsy, and fragments are collected with one of an array of basket devices available. Modern technology has established ureteroscopy as a standard of care for the management of upper tract calculi less than 2 cm in patients of all ages.