Contact ureterolithotripsy of a giant ureteral stone in a 3-year-old child

Giant ureteral stones in young children are extremely rare and their surgical treatment tactics are variable. The present case describes a case of effective and safe endoscopic treatment of giant ureteral stones in a young child. The patient is a 3-year-old male child. Examination findings of abdominal pain and fever verified a left distal ureteric stone up to 30 mm complicated by ureterohydronephrosis. The first treatment stage was ureteral stenting, in which the stone migrated to the middle ureteral third. The second treatment stage was contact ureterolithotripsy with a 9 Ch semi-rigid ureteroscope («Richard Wolf» GmbH, Knittlingen, Germany) and Swiss LithoClast® 2 pneumatic lithotripter («E.M.S. Electro Medical Systems» S.A., Nyon, Suisse), ureteral stenting (2-way PigTail, 4.5 Ch). The third treatment stage in the delayed period was extracorporeal shockwave lithotripsy of the steinstrasse using the Dornier Compact Sigma («Dornier MedTech» GmbH, Weßling, Germany) and stent removal. Residual stones were not revealed according to the follow-up examination. No treatment complications were registered. The multimodal staged treatment of a giant ureteral stone resulted in its complete elimination. Next-step ureteral endoscopy made it possible to identify concomitant pathology of the proximal ureter, which required its evaluation in the delayed period. Ureteral stenting contributed to the restoration of renal function. The result achieved reflects the maximum efficiency and high safety of the surgical technique applied.

1. Gudkov R.A., Slobodyanyuk O. Urolithiasis in children. Russian pediatric journal. 2021;24(4):253. (In Russ.) EDN: NDPIDJ

2. Gadzhiev N, Prosyannikov M, Malkhasyan V, Akopyan G, Somani B, Sivkov A, Apolikhin O, Kaprin A. Urolithiasis prevalence in the Russian Federation: analysis of trends over a 15-year period. World J Urol. 2021;39(10):3939-3944. https://doi.org/10.1007/s00345-021-03729-y

3. Kim HW, Kim KD, Moon YT, Kim SC. A giant ureteral stone. J Korean Med Sci. 1995;10(1):48-50. https://doi.org/10.3346/jkms.1995.10.1.48

4. Resorlu B, Kara C, Resorlu EB, Unsal A. Effectiveness of ultrasonography in the postoperative follow-up of pediatric patients undergoing ureteroscopic stone manipulation. Pediatr Surg Int. 2011;27(12):1337-41. https://doi.org/10.1007/s00383-011-2979-0

5. Skolarikos A, Neisius A, Petřík A, Somani B, Thomas K, Gambaro G. Urolithiasis. In: EAU Guidelines. Edn. presented at the EAU Annual Congress Amsterdam, 2022. ISBN 978-94-92671-16-5. URL: https://uroweb.org/guideline/urolithiasis/

6. Torricelli FC, Monga M, Marchini GS, Srougi M, Nahas WC, Mazzucchi E. Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta - analysis of randomized controlled trials. Int Braz J Urol. 2016;42(4):645-54. https://doi.org/10.1590/S1677-5538.IBJU.2015.0696

7. Lai S, Jiao B, Diao T, Seery S, Hu M, Wang M, Hou H, Wang J, Zhang G, Liu M. Optimal management of large proximal ureteral stones (>10 mm): A systematic review and meta-analysis of 12 randomized controlled trials. Int J Surg. 2020;80:205-217. https://doi.org/10.1016/j.ijsu.2020.06.025

8. Shao Y, Wang DW, Lu GL, Shen ZJ. Retroperitoneal laparoscopic ureterolithotomy in comparison with ureteroscopic lithotripsy in the management of impacted upper ureteral stones larger than 12 mm. World J Urol. 2015;33(11):1841-5. https://doi.org/10.1007/s00345-015-1545-0

9. Wang Y, Zhong B, Yang X, Wang G, Hou P, Meng J. Comparison of the efficacy and safety of URSL, RPLU, and MPCNL for treatment of large upper impacted ureteral stones: a randomized controlled trial. BMC Urol. 2017;17(1):50. https://doi.org/10.1186/s12894-017-0236-0

10. Kumar A, Vasudeva P, Nanda B, Kumar N, Jha SK, Singh H. A Prospective Randomized Comparison Between Laparoscopic Ureterolithotomy and Semirigid Ureteroscopy for Upper Ureteral Stones >2 cm: A Single-Center Experience. J Endourol. 2015;29(11):1248-52. https://doi.org/10.1089/end.2013.0791

11. Jeong YB, Park JK, Kim HJ, Kim YG, Kim MK. Giant ureteral stone in a patient with a single functioning kidney: a case report. Clin Nephrol. 2011;75(6):547-9. https://doi.org/10.5414/cn106668

12. Wang Y, Chang X, Li J, Han Z. Efficacy and safety of various surgical treatments for proximal ureteral stone ≥10mm: A systematic review and network meta-analysis. Int Braz J Urol. 2020;46(6):902-926. https://doi.org/10.1590/S1677-5538.IBJU.2019.0550

13. Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69(3):475-82. https://doi.org/10.1016/j.eururo.2015.07.041

14. Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, Pace KT, Pais VM Jr, Pearle MS, Preminger GM, Razvi H, Shah O, Matlaga BR. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART II. J Urol. 2016;196(4):1161-9. https://doi.org/10.1016/j.juro.2016.05.091

15. Gofrit ON, Pode D, Meretyk S, Katz G, Shapiro A, Golijanin D, Wiener DP, Shenfeld OZ, Landau EH. Is the pediatric ureter as efficient as the adult ureter in transporting fragments following extracorporeal shock wave lithotripsy for renal calculi larger than 10 mm.? J Urol. 2001;166(5):1862-4. PMID: 11586249

16. Resorlu B, Unsal A, Tepeler A, Atis G, Tokatli Z, Oztuna D, Armagan A, Gurbuz C, Caskurlu T, Saglam R. Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in children with moderate-size kidney stones: results of multi-institutional analysis. Urology. 2012;80(3):519-23. https://doi.org/10.1016/j.urology.2012.04.018

17. Mugiya S, Ozono S, Nagata M, Takayama T, Nagae H. Retrograde endoscopic management of ureteral stones more than 2 cm in size. Urology. 2006;67(6):1164-8; discussion 1168. https://doi.org/10.1016/j.urology.2006.01.088

18. Kumar V, Ahlawat R, Banjeree GK, Bhaduria RP, Elhence A, Bhandari M. Percutaneous ureterolitholapaxy: the best bet to clear large bulk impacted upper ureteral calculi. Arch Esp Urol. 1996;49(1):86-91. PMID: 8678608

19. Maheshwari PN, Oswal AT, Andankar M, Nanjappa KM, Bansal M. Is antegrade ureteroscopy better than retrograde ureteroscopy for impacted large upper ureteral calculi? J Endourol. 1999;13(6):441-4. https://doi.org/10.1089/end.1999.13.441

20. Goel R, Aron M, Kesarwani PK, Dogra PN, Hemal AK, Gupta NP. Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries. J Endourol. 2005;19(1):54-7. https://doi.org/10.1089/end.2005.19.54

21. Mak D, Wragg R, Chandran H, McCarthy R, Parashar K. Silent But Giant: Giant ureteric calculus in a 7-year-old boy. J Surg Case Rep. 2010;2010(5):8. https://doi.org/10.1093/jscr/2010.5.8

22. Dincel N, Resorlu B, Unsal A, Tepeler A, Silay MS, Armağan A, Diri A, Sancaktutar AA, Ziypak T, Mir S. Are small residual stone fragments really insignificant in children? J Pediatr Surg. 2013;48(4):840-4. https://doi.org/10.1016/j.jpedsurg.2012.07.061

23. El-Assmy A, El-Nahas AR, Harraz AM, El Demerdash Y, Elsaadany MM, El-Halwagy S, Sheir KZ. Clinically Insignificant Residual Fragments: Is It an Appropriate Term in Children? Urology. 2015;86(3):593-8. https://doi.org/10.1016/j.urology.2015.06.017