Pediatric bilateral ureteral stone successfully removed usin
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With the recent development of ureteroscopy and laser devices, pediatric cases have been reported with the treatment of renal or ureteral stones using ureteroscopic lithotripsy. Recently, single‐use flexible ureteroscopy came into clinical use and showed efficacy without inferiority to flexible reusable ureteroscopy. However, due to the costs associated with flexible ureteroscopy, not all cases have been treated with ureteroscopic lithotripsy.

A 12‐year‐old boy received steroid for his minimal change nephrotic syndrome for 10 years. During the follow‐up observation of his renal function, bilateral renal and ureteral stones and hydronephrosis were observed (Figure 1A and B). Because of his fever UTI without pain, bilateral ureteral stent insertion was performed. Because this was a bilateral case requiring one‐time invasive treatment in a pediatric patient, bilateral ureteroscopic lithotripsy was planned

One month after initial ureteral stent insertion, transurethral lithotripsy was planned. Under general anesthesia, the author first tried to remove the ureteral stents, but due to heavy encrustation, the stents could not be removed. The doctor then performed rigid ureteroscopy beside the encrusted ureteral stents to confirm the encrusted area and successfully removed then. An 11/13‐Fr ureteral access sheath (UAS) was then inserted under fluoroscopic guidance just in front of the target stone, and the target stone was observed using single‐use flexible ureteroscopy. Ho: YAG laser lithotripsy was performed at the settings of 1.0J 5 Hz, and then, the target stones were removed using a basket device.

A double‐J ureteral stent was inserted at the conclusion of lithotripsy. As the ureteral stent on the other side was also encrusted, the author managed to remove it with the same approach. The renal and target ureteral stent were then also removed. A single‐J stent was inserted at the conclusion of lithotripsy.

After confirming he had no fever on the next day after surgery, the single‐J stent was removed. After confirming he had no hydronephrosis by ultrasonography, the double‐J stent was also removed under general anesthesia (Figure 1C and D). Postoperative urinary analysis showed ph5.5, and serum creatinine level was 1.07. Stone chemical analysis was uric acid. He administrated potassium citrate and following up X‐ray examination every 6 months.

Single‐use flexible ureteroscopy with a reduced diameter of ureteroscope has entered clinical use and is now available for treating pediatric cases with ureteroscopic lithotripsy using a Ho: YAG laser. In the present case, pediatric ureteroscopic lithotripsy was performed using single‐use flexible ureteroscopy.

source:https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.2817?af=R
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