Ureteroscopy is considered a safe and effective treatment modality for ureteral stones in the pediatric population. However, patients with scoliosis or spinal hardware may have anatomic variability that makes ureteroscopy challenging due to ureteral deviation or tortuosity.
Objective: We reviewed 130 ureteroscopic procedures at our institution to determine if presence of spinal hardware or severe spinal deformities was associated with increased complications or worsened treatment efficacy.
Methods: A retrospective chart review was performed on 130 ureteroscopic procedures in 102 patients. Patients were divided into two groups: those with normal spinal anatomy and those with spinal abnormalities including spinal hardware or moderate to severe scoliosis. Parameters evaluated included patient demographics, stone burden, intraoperative complications (including urinary extravasation, bleeding, or need to abort procedure), and stone free status.
Results: Of 130 ureteroscopic procedures between 2002 and 2010, 25 ureteroscopies were performed for purposes other than stone disease (gross hematuria, filling defects, or encrusted ureteral stents). The remainder of ureteroscopies (105) were performed for stone disease. Nine patients had spinal hardware or significant spinal deformities including moderate to severe scoliosis. When comparing both the intraoperative complications as well as stone free status, there was a difference between those patients with spinal abnormalities and those without. Of 90 ureteroscopies performed for stones in normal anatomy patients, stone free rate was 61%, compared to 35.7% in patients with spinal deformities. There were 13 total complications (Satava Grade I or II), 40% in spinal deformity patients compared to 6.1% in normal anatomy patients.
Conclusion: Spinal hardware and spinal deformities contribute to increased complications and worsened stone free rates during pediatric ureteroscopy compared to normal anatomy pediatric patients. Our experience with ureteroscopy in patients with spinal deformities suggests it may not be as safe or efficacious as in the general pediatric population but it can still be utilized as a primary modality.
Written by:
Colangelo CJ, Kaplan GW, Holmes N, Palazzi-Churas K, Chiang G Are you the author?
UC San Diego, 200 W Arbor Drive, San Diego, California, United States, 92103;
Reference: J Endourol. 2012 Dec 23. (Epub ahead of print)
doi: 10.1089/end.2012.0306
PubMed Abstract
PMID: 23259915
