Retrograde proximal rigid ureteroscopy and pyeloscopy in prepubertal children: Safe and effective

Purpose: Traditionally, rigid ureteroscopy in adults has been reserved for distal ureteral procedures, due to the risk of injury associated with proximal ureteroscopy. However, the safety of proximal rigid ureteroscopy in prepubertal children is not well established. Materials and Methods: We retrospectively evaluated all prepubertal children (12 years old and younger) who underwent attempted rigid proximal ureteroscopy and pyeloscopy. The indications for ureteroscopy were treatment of ureteral and/or renal pelvic calculi, and evaluation of hematuria. All patients were evaluated postoperatively with renal and bladder ultrasonography and abdominal radiography (if stone was visible before treatment). Results: A total of 24 consecutive children 3.4 to 12 years old underwent 24 ureteropyeloscopic procedures. Of these children 20 (83%) successfully underwent 20 rigid ureteroscopic and pyeloscopic procedures. However, 4 procedures (17%) were converted from rigid to flexible endoscopy to perform 4 successful ureteropyeloscopies. The indications for ureteroscopy were treatment of ureteral and/or renal pelvic calculi in 22 patients and evaluation of hematuria in 2. Followup was 0.6 to 3.6 years (mean 1.9) for the patients undergoing rigid ureteropyeloscopy. All children with calculi were rendered stone-free based on direct visualization by complete ureteroscopy and pyeloscopy of the affected system. No complications occurred during any of the procedures. Conclusions: Proximal rigid ureteroscopy and pyeloscopy can be safely applied toward treatment of proximal ureteral and renal pelvic calculi as well as diagnostic ureteropyeloscopy in prepubertal children. The technique has several advantages compared to flexible ureteroscopy.