Ureteral Access Sheath For The Management Of Pediatric Renal And Ureteral Stones: A Single Center Experience

Purpose: Ureteral access sheaths were developed to facilitate difficult ureteroscopic access in adults. We report our use of the ureteral access sheath during standard ureteroscopic procedures in the pediatric stone population.Materials and Methods: Eight patients underwent flexible ureteroscopy and holmium laser lithotripsy for symptomatic renal and ureteral calculi between October 2003 and October 2004. Average patient age was 9.3 years (range 4 to 13). There were 4 males and 4 females. Five of 8 patients had bilateral stones and underwent bilateral endoscopic stone treatment at the same operation. A 14Fr 20 cm Flexor(R) ureteral access sheath was used for dilation and access of the ureter. Flexible pediatric ureteroscope was used to enter the ureter and collecting system for stone retrieval and fragmentation.Results: All patients were rendered stone-free in a single operative setting. Average operative time was 99 minutes (range 65 to 130). Average total stone burden for the group was 9 3 mm. All patients received stents after the procedure. There were no perioperative complications. All patients were followed with renal-bladder ultrasound and plain x-ray. All patients were stone-free at a mean followup of 10 months (median 11).Conclusions: Routine use of a ureteral access sheath in children facilitates flexible ureteroscopy with lithotripsy of multiple renal and proximal ureteral stones. The procedure is safe and time efficient, and is associated with minimal morbidity. Larger prospective studies in children with longer followup are warranted.