Treatment of distal ureteral stones in children: Similarities to the American Urological Association guidelines in adults

Purpose: The American Urological Association (AUA) published clinical guide lines for the treatment of ureteral calculi in adults and note that up to 9 8% of stones less than 5 mm. in diameter will pass spontaneously. Ureterosc opy and shock wave lithotripsy were acceptable treatment choices for stones less than 10 mm. in diameter in the distal ureter. We reviewed our managem ent of distal ureteral stones in children to see if the AUA Guidelines for adults would apply. Materials and Methods: A total of 14 males and 19 females with a mean age o f 12 years (range 0.5 to 17) required hospitalization in the last 6 years f or distal ureteral obstruction due to stones. Excretory urography or comput erized tomography was performed in all cases, and mean stone size was 4 mm. (range 1 to 15). When stones did not pass spontaneously most patients were treated with ureteroscopic laser lithotripsy. Results: There were 12 (36%) with a mean age of 11 years and a mean stone s ize of 2 mm. (range 1 to 3) who passed stones spontaneously with intravenou s hydration and narcotics. No child passed a stone 4 mm. or greater spontan eously in this series. Of 21 patients (64%) with a mean age of 12 years and a mean stone size of 5 mm. (range 1 to 15) 2 were treated with ureteral st ents, 17 with ureteroscopic lithotripsy and 2 with shock wave lithotripsy. All patients were stone-free at the end of the procedures. The stone compos ition was predominantly calcium oxalate, Mean followup was 2 years. Conclusions: Similar to the AUA guidelines in adults, most stones less than 3 mm. in diameter in the distal ureter of children Will pass spontaneously . Stones 4 mm or greater in the distal ureter are likely to require endosur gical treatment. Ureteroscopy and shock wave lithrotripsy have a high succe ss rate for stones between 4 and 15 mm. in the distal ureter. Needle ureter oscope and laser lithotripsy have allowed more stones to be treated safely and effectively in smaller children.