Ureteroscopy and Laser Lithotripsy for Large (≥2 cm) Upper Tract Urinary Stones in Pediatric Patients: Outcomes from a Pediatric Endourology Referral Center

<b><i>Introduction:</i></b> The global prevalence of pediatric urolithiasis is increasing. Managing large urinary stones in pediatric populations poses a particular clinical challenge. This study evaluates the safety and efficacy of ureteroscopy and laser stone fragmentation (URSL) for treating large upper urinary tract stones in pediatric patients. <b><i>Methods:</i></b> A retrospective analysis of the prospective database was conducted on pediatric patients who underwent URSL for stones ≥2 cm between 2011 and 2023 (14 years) at the University Hospital Southampton, UK. Patient demographics, stone characteristics, operative details, stone-free rates (SFR), and complications were analyzed. <b><i>Results:</i></b> In total, 23 patients (median age 11 years) underwent URSL. The mean total stone length was 24.7 ± 6.49 mm, with 12 (52.2%) having multiple stones. Prestenting, ureteral access sheath, and postop stenting were used in 9 (39.1%), 4 (17.4%), and 10 patients (43.5%), respectively. Holmium laser was used, and the SFR after the first procedure was 91.3%, with no procedural complications. There was only one complication (postoperative fever, Clavien-Dindo I) reported. The median length of stay was 1 day. <b><i>Conclusion:</i></b> URSL is safe and efficient for treating large upper tract urinary stones in pediatric patients, demonstrating high SFR and low complication rate. This could offer an alternative treatment modality to percutaneous surgery in large upper urinary tract stones, although parents need to be adequately counseled about it.