Techniques for stenting the normal and obstructed ureter

Ureteroscopy: The standard of care in the management of upper tract urolithiasis in children

Objectives

Advances in technology and the continued evolution in the design of ureteroscopes now permit a primary endoscopic approach to the upper urinary tract of pediatric patients on a routine basis to treat a diverse group of conditions that include urolithiasis, hematuria and strictures. The purpose of this review article is to demonstrate that ureteroscopic lithotripsy is now to be considered the standard of care in the management of upper tract urolithiasis in the pediatric patient, replacing shockwave lithotripsy (ESWL) as the first line of therapy. Additionally, the article will discuss the available endoscopic equipment and the lessons learned over the years to optimize the success of these procedures in children.

Materials and Methods

A systematic review of articles written about ureteroscopy (URS) in the contemporary urological literature (1990-2009) on PubMed was undertaken. The success rates and complications of pediatric ureteroscopic procedures were abstracted from the identified publications and the results were tabulated and compared with the success rates of shockwave lithotripsy.

Results

In over 832 URS cases, there was a 5.9% complication rate and a stone-free rate of 93.4%. The stone-free rates of URS are superior to those obtained with the published success rates with ESWL of 80.3% in 1,839 cases.

Conclusions

The safety and outcomes of ureteroscopic lithotripsy in the management of pediatric urolithiasis now justify that this treatment modality be considered the standard of care and first line of therapy in the management of children who present with upper tract stones.

A new tool to aid the urologist in the placement of stents for impacted ureteral stones or strictures: the glide catheter

We describe a technique one can use when only a lubricious wire is able to pass an impacted stone that could otherwise not be passed, over which a new hydrophilic "Glide Catheter is then passed beyond the stone. The lubricious wire can then be exchanged for a stiffer wire that will aid the retrograde passage of a ureteral catheter, stent, or other endourologic device in both a safe and effective manner.