Endoscopic treatment of children with ureteral stones: analysis of the efficacy and safety of contact ureteral lithotripsy

BACKGROUND: Contact ureteral lithotripsy is considered a minimally invasive treatment method that can reduce the recurrence rate of urolithiasis. However, its use in children requires a specialized approach due to the unique anatomical and physiological characteristics of pediatric patients. AIM: To study the efficacy and intraoperative complication rate in children with ureteral stones undergoing contact ureteral lithotripsy. MATERIALS AND METHODS: A retrospective study of 253 children who underwent contact ureteral lithotripsy between 2018 and 2022 was conducted. The mean age of the patients was 9.8±4.1 years, with a predominance of boys (70.4%). Pneumatic and laser lithotripters were used for fragmentation. In some cases, a ureteral stent was placed. The efficacy and safety of the procedure was assessed in children, taking into account the localization of stones and the patient’s age. RESULTS: The stones were located in the left ureter in 57.7% of cases and in the right ureter in 42.3% of cases. The stones were distributed according to their localization in the distal (30.1%), middle (27.6%), and proximal (42.3%) parts of the ureter. The mean stone size was 10.2±1.3 mm. Laser lithotripsy was used in 58% of cases, while pneumatic lithotripsy was performed in 42% of cases, with a stone-free rate of 92.1%. The mean procedure duration was 62.8±19.3 min, while the length of hospital stay was 2.3±0.5 days. Intraoperative complications were observed in 20 patients (7.9%), with a higher rate in children aged 4–7 years (3.9%), including stone transposition (1.2%) and failure of retrograde access (1.9%). Conversion to open surgery was required in 0.6% of cases due to anatomical complexities in younger patients. CONCLUSIONS: Contact ureteral lithotripsy is an effective and safe method for ureteral stone removal in children, particularly when using a laser lithotripter, which reduces operative time and minimizes the risk of tissue damage. However, in younger children, additional precautions and an individual approach are required to minimize the risk of complications.