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      Ureteroscopy for Stone Disease in Paediatric Population is Safe and Effective in Medium-Volume and High-Volume Centres: Evidence from a Systematic Review

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          Abstract

          Purpose of Review

          The incidence of urinary stone disease among the paediatric population is increasing. Whilst there has been a rise in the number of original studies published on ureteroscopy (URS) in children, critical review still remains under-reported.

          Recent Findings

          A Cochrane style systematic review was performed to identify all original articles on URS (minimum of 25 cases) for stone disease in paediatric patients between Jan. 1996 and Dec. 2016. Based on the number of reported cases, centres were divided into medium (25–49 cases) and high (≥ 50 cases) volume studies.

          Thirty-four studies (2758 children) satisfied our search criteria and were included in this review. The mean stone size was 8.6 mm with an overall stone-free rate (SFR) of 90.4% (range 58–100). Medium-volume centres reported a mean SFR of 94.1% (range 87.5–100), whilst high-volume centres reported a mean SFR of 88.1% (range 58–98.5). Mean number of sessions to achieve stone-free status in medium-volume and high-volume groups was 1.1 and 1.2 procedures/patient respectively. The overall complication rate was 11.1% (327/2994). Breakdown by Clavien grade was as follows: Clavien I 69% and Clavien II/III 31%. There were no Clavien IV/V complications, and no mortality was recorded across any of the studies. The overall failure to access rate was 2.5% (76/2944).

          Medium-volume and high-volume studies had overall complication rates of 6.9% (37/530) and 12.1% (287/2222) respectively, but there was no significant difference in major or minor complications between these two groups.

          Summary

          Ureteroscopy is a safe and effective treatment for paediatric stone disease. Medium-volume centres can achieve equally high SFRs and safety profiles as high-volume centres. Despite the rarity of paediatric stone disease, our findings might increase the uptake of paediatric URS procedures.

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          Most cited references40

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          Worldwide Trends of Urinary Stone Disease Treatment Over the Last Two Decades: A Systematic Review.

          Numerous studies have reported on regional or national trends of stone disease treatment. However, no article has yet examined the global trends of intervention for stone disease.
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            Ureteroscopy for the treatment of urolithiasis in children.

            Ureteroscopy for treating urolithiasis in prepubertal children has become more common with the advent of smaller instruments. We reviewed our experience with ureteroscopy for urolithiasis in this cohort of patients as well as the literature using this treatment modality in children. Between 1994 and 2000 we performed 27 ureteroscopic stone extractions in 25 children. Ureteroscopy was done in a manner similar to that in adults. Ureteral dilation was performed when necessary to access the ureter. A stent was placed postoperatively if there was significant ureteral trauma. Of the 25 children 13 were male and 12 were female. Average age was 9.2 years (range 3 to 14). Stones were 2 to 12 mm. in greatest diameter (average 6). Of the 27 procedures the ureteral orifice was dilated before stone treatment in 15 (56%), while in 19 (70%) a stent was placed afterward. No intraoperative and 2 postoperative complications were identified. Overall 92% of the children were rendered stone-free after 1 procedure and 100% were stone-free after 2. Ureteroscopy for urolithiasis in prepubertal children is safe and effective. Routine ureteral dilation and ureteral stent placement are not always necessary in these patients.
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              Is Open Access

              Flexible ureterorenoscopy: Tips and tricks

              With advancement in technology, improvement in endoscope and ancillary equipment, more complex procedures can be performed using flexible ureterorenoscopy. In this review article we provide a summary of flexible ureterorenoscopic procedures with “tips and tricks” for success for each type of procedure. It looks at the disposables used with flexible ureterorenoscopic procedures, set up and patient positioning for gaining access, insertion and handling of scope and the use of urethral access sheath. We also provide techniques for various flexible ureterorenoscopic procedures including management of renal stones, calyceal diverticula and upper tract urothelial tumours.
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                Author and article information

                Contributors
                sr2g11@soton.ac.uk
                patrick.jones1@nhs.net
                ameliapietr@gmail.com
                stephengriffin69@googlemail.com
                bhaskarsomani@yahoo.com
                Journal
                Curr Urol Rep
                Curr Urol Rep
                Current Urology Reports
                Springer US (New York )
                1527-2737
                1534-6285
                18 October 2017
                18 October 2017
                2017
                : 18
                : 12
                : 92
                Affiliations
                [1 ]ISNI 0000000103590315, GRID grid.123047.3, Department of Urology, , University Hospital Southampton, ; Southampton, UK
                [2 ]ISNI 0000000103590315, GRID grid.123047.3, Department of Paediatric Urology, , University Hospital Southampton, ; Southampton, UK
                Article
                742
                10.1007/s11934-017-0742-3
                5693963
                29046982
                c92c8006-be2d-4e03-8890-6481fe15b9ec
                © The Author(s) 2017

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Funding
                Funded by: University of Southampton
                Categories
                Pediatric Urology (D Weiss, Section Editor)
                Custom metadata
                © Springer Science+Business Media, LLC, part of Springer Nature 2017

                Urology
                paediatric,ureteroscopy,volume,complications,success,urolithiasis
                Urology
                paediatric, ureteroscopy, volume, complications, success, urolithiasis

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