Introduction
Material and Methods
Evidence Acquisition: Criteria for Considering Studies for This Review
Inclusion Criteria
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Studies reporting on outcomes following ureteroscopy in paediatric populations
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Patients aged ≤ 18
Exclusion Criteria
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Study sample size < 25 patients
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Non-English language articles
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Animal studies
Search Strategy and Study Selection
Outcomes of Interest
Primary Outcomes
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Procedure-related complications (graded according to Clavien-Dindo system)
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Stone-free rates (SFRs)
Secondary Outcomes
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Comparison of outcomes for ureteroscopy performed in medium-volume centres (reporting 25–49 procedures) and high-volume centres (reporting ≥ 50 procedures).
Data Extraction and Analysis
Results
Author | Journal | Year | Country | No. of procedures | Sample size (male/female) | Mean age (years) (range) | Mean stone size (range) (mm) |
---|---|---|---|---|---|---|---|
Medium-volume centres | |||||||
Schuster [6] | Journal of Urology | 2002 | USA | 27* | 25 (13/12) | 9.2 (3 to 14) | 6 (2–12) |
Dogan [7] | BJU International | 2004 | Turkey | 35* | 35 (15/20) | 6.2 (1 to 14) | 8 (4–15) |
Satar [8] | Journal of Urology | 2004 | Turkey | 33* | 33 (NR) | 7.4 (0.75 to 15) | 5.3 (3–10) |
Al-Busaidy [9] | BJU International | 2004 | Oman | 28* | 26 (14/12) | 6.5 (2–12) | 12.1 (4–22) |
Thomas [12] | J Urol | 2005 | USA | 33* | 29 (15/14) | 7.8 (0.4–12) | 6 (3–9) |
El-assmy [13] | Journal of Endourology | 2006 | Egypt | 33* | 32 (NR) | 8.7 (2–15) | 7 (4–15) |
Ertuhan [16] | Journal of Endourology | 2007 | Turkey | 41* | 41 (16/25) | 9.5 (3–15) | 5.6 (4–10) |
Corcoran [17] | J Urol | 2008 | USA | 30* | 30 | 9.7 (2.2–14.4) | 8.8 (1.5–25) |
Yeow [20] | J Indian Assoc Pediatr Surg | 2009 | Australia | 26* | 26 (14/12) | 8.2 (0.25–15) | 10.3 (3–21) |
Chedgy [31] | Urologia Internationalis | 2015 | UK | 32* | 21 (13/8) | 8.6 (1.4–16) | 9.6 (5–20) |
Featherstone [33••] | Journal of Paediatric urology | 2016 | UK | 35* | 18 (7/11) | 10.4 (3.6–15) | 13.2 (10–25) |
Iqbal [35] | Urology | 2016 | Pakistan | 37* | 37 (25/12) | 8.37 (NR) | 10.01 (NR) |
Utangac [36] | JCPSP | 2016 | Turkey | 34* | 34 (22/12) | 0.8 (0.33–12) | NR |
High-volume centres | |||||||
Al Busaidy [4] | British Journal of Urology | 1997 | Oman | 50** | 43 (29/14) | 6.2 (0.5–12) | 12.6 (4–22) |
Bassiri [5] | Journal of Endourology | 2002 | Iran | 66** | 66 (NR) | 9 (2–15) | 8 (5–15) |
Minevich [10] | Journal of Urology | 2005 | USA | 81** | 71 (39/32) | 7.5 (1–12) | NR |
Raza [11] | Journal of Endourology | 2005 | UK | 52** | 35 (25/10) | 5.9 (0.9–15) | 8.8 (3–20) |
Gedik [14] | International Urology and Nephrology | 2007 | Turkey | 54** | 54 (32/22) | 8.5 (1–16) | 7.1 (4–12) |
Smaldone [15] | Journal of Urology | 2007 | USA | 115** | 100 (42/58) | 13.2 | 8.3 |
Tanaka [18] | Journal of Urology | 2008 | USA | 52** | 50 (31/19) | 7.9 (1.2–13.6) | 8 (1–16) |
Kim [19] | Journal of Urology | 2008 | USA | 170** | 167 (89/78) | 5.2 (0.25–18) | NR |
Tanriverdi [21] | Paediatric Surgery International | 2010 | Turkey | 65** | 65 (39/26) | 9.1 (2–16) | 6.1 (3–24) |
Turunc [22] | Journal of Endourology | 2010 | Turkey | 66** | 61 (NR) | 8.1 (0.5–16) | 9.5 (3–30) |
Ghazaleh [23] | Saudi Journal of Kidney Diseases and Transplantation | 2011 | Jordan | 78** | 56 (38/18) | 8.2 (6–14) | 8.2 (4–20) |
Nerli [24] | Journal of Endourology | 2011 | India | 88** | 80 (69/11) | 9.5 (6–12) | 12 (9–15) |
Dogan [25•] | Journal of Urology | 2011 | Turkey | 660** | 642 (265/377) | 7.5 (0.33–17) | 10.2 (7–16) |
Yucel [26] | World journal of urology | 2011 | Turkey | 54** | 48 (28/20) | 7.6 (0.75–18) | 8.9 (NR) |
Atar [27] | Urological research | 2012 | Turkey | 69** | 64 (23/41) | 4.3 (NR) | NR |
Resorlu [28] | Urology | 2012 | Turkey | 95** | 95 (53/42) | 9.3 (1–17) | 14.3 (NR) |
Jurkiewicz [29] | Urolithiasis | 2013 | Germany | 157** | 126 (66/60) | 7.5 (0.8–17) | 7.2 |
Ezkurt [30] | Urolithiasis | 2013 | Turkey | 65** | 65 (31/34) | 4.3 (0.5–7) | 14.66 (7–30) |
Sen [32] | Journal of Paediatric urology | 2015 | Turkey | 175** | 175 (101/74) | 4 (NR) | 9.6 (5–20) |
Gokce [34] | Urology | 2016 | Turkey | 116** | 116 (78/38) | 9.5 (NR) | 9.4 (NR) |
Other | |||||||
Guven [37] | Urology | 2016a
| Global (over 23 countries) | 192 | 192 (109/83) | 10.3 (NR) | 4.56 (1.96–9.43) |
Outcome Measures
Author | Stone location (n) | SFR (%) | Failures (n) | Complications (n) | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Upper ureter | Mid ureter | Lower ureter | Renal pelvis | Upper pole | Mid pole | Lower pole | Other stones | ||||
Medium-volume centres | |||||||||||
Schuster [6] | NR | NR | NR | NR | NR | NR | NR | NR | 100 | 0 | Stent migration (1), pyelonephritis (1) |
Dogan [7] | 2 | – | 33 | – | – | – | – | – | 97 | 1 | Ureteric perforation (2) |
Satar [8] | 6 | 3 | 26 | – | – | – | – | – | 94 | 2 | UTI (1) |
Al-Busaidy [9] | 6 | 5 | 17 | – | – | – | – | – | 92 | 2 | Transient haematuria (4), fever (2) |
Thomas [12] | 3 | 5 | 24 | 1 | – | – | – | – | 96 | 1/33 | Extravasation (1) |
El-Assmy [13] | 2 | 2 | 29 | – | – | – | – | – | 96.9 | 1/33 | Extravasation (1), transient haematuria (1) |
Erturhan [16] | 4 | 15 | 27 | – | – | – | – | 87.7 | 5/41 | Nil | |
Corcoran [17] | NR | NR | NR | NR | NR | NR | NR | NR | 94 | 2/30 | Ureteral perforation (2), urinoma (1) |
Yeow [20] | NR | NR | NR | NR | NR | NR | NR | NR | 88.5 | 3/26 | Nil |
Chedgy [31] | NR | NR | NR | NR | NR | NR | NR | NR | 95 | 0 | UTI (1) |
Featherstone [33••] | 2 | – | 5 | 4 | 7 | 3 | 21 | 4 | 89 | 1 | Nil |
Iqbal [35] | NR | NR | NR | NR | NR | NR | NR | NR | 100 | 0 | Pyelonephritis (2), haematuria (4) |
Utangac [36] | 4 | 9 | 2 | – | – | – | – | – | 94.1 | 0 | Minimal bleeding (2), ureteral perforation (1), UTI (2) |
High-volume centres | |||||||||||
Al Busaidy [4] | 9 | 7 | 34 | – | – | – | – | – | 93 | 3/43 | Ureteric perforation (2) |
Bassiri [5] | 2 | 5 | 59 | – | – | – | – | – | 88 | 3/66 | Transient haematuria (11), pyelonephritis (3), renal colic (1) |
Minevich [10] | 16 | 14 | 28 | 7 | – | – | – | – | 98 | 0 | Nil |
Raza [11] | 0 | 3 | 72 | – | – | – | – | 2 | 87.2 | 0 | Ureteric perforation (2), urinary retention (1), mild fever (5), mucosal tear (1) |
Gedik [14] | 3 | 16 | 25 | – | – | – | – | – | 77.8 | 2 | Pyrexia (3) |
Smaldone [15] | 19 | 11 | 37 | 6 | 10 | – | 17 | – | 91 | 0 | Ureteric perforation/extravasation (5), ureteral stricture (1) |
Tanaka [18] | – | – | – | 27 | – | – | 13 | 11 | 58 | 0 | Re-admission due to nausea and vomiting (1) |
Kim [19] | – | 47 | 19 | – | – | – | 87 | 14 | 98.5 | 0 | Nil |
Tanriverdi [21] | 5 | 2 | 33 | – | – | – | – | – | 89.2 | 2 | Mucosal lacerations (2), minor haematuria (1) |
Turunc [22] | 7 | 9 | 50 | – | – | – | – | – | 92.4 | 5 | Pyrexia (1) |
Ghazaleh [23] | – | – | – | 34 | 6 | 4 | – | 24 | 94.8 | 0 | UTI (3), haematuria (1) |
Nerli [24] | 56 | – | – | – | – | – | – | 24 | 97.5 | 2 | Intra-operative bleeding (6), self-limiting post-operative bleeding (8), pyrexia (4) |
Dogan [25•] | 96 | 73 | 480 | – | – | – | – | 21 | 90 | 9/660 | Stone migration (8), mucosal laceration (1), broken catheter (1), ureteral perforations (5), haematuria (2) (1 intra-op, 1 post-op), post-op pain (2), febrile UTI (20), urinary retention (1), 1 urethral stone (1), late ureterovesical junction obstruction (4) |
Yucel [26] | NR | NR | NR | NR | NR | NR | NR | NR | 84.3 | 8/54 | Ureteral perforation (3), urosepsis (30), ureteral obstruction with stone fragment (1) |
Atar [27] | 6 | 9 | 54 | – | – | – | – | – | 85.6 | 12 | Mild haematuria (8), ureteral laceration (8), ureteric perforation (4), urinoma (1), renal colic (5), febrile UTI (9), urinary retention (7), bleeding/false route/perforation intra-operatively (5) |
Resorlu [28] | NR | NR | NR | NR | NR | NR | NR | NR | 92.6 | 0 | Minor complications (Clavien I/II) 8.4% Major complications (Clavien III–V) nil |
Jurkiewicz [29] | NR | NR | NR | NR | NR | NR | NR | NR | 98.1 | 4/15 | Ureteral perforation (1), ureterovesical stenosis (1) |
Ezkurt [30] | – | – | – | 22 | 10 | 12 | 28 | – | 92.3 | 5/65 | Pyelonephritis (10), haematuria (6), ureteral wall injury (2) |
Sen [32] | NR | NR | NR | NR | NR | NR | NR | NR | 66 | NR | Fever (30), ureteral laceration (8), sepsis (6) |
Featherstone [33••] | 2 | – | 5 | 4 | 7 | 3 | 21 | 4 | 89 | 1 | Nil |
Gokce [34] | NR | NR | NR | NR | NR | NR | NR | NR | 87 | 3/116 | Mucosal injury (8), renal colic (22) |
Other | |||||||||||
Guven [37] | NR | NR | NR | NR | NR | NR | NR | NR | 89.2 | NR | Pain (1), stricture (2) |
Nature of complication | Clavien grade | Number of complications (n) | |
---|---|---|---|
Medium volume | High volume | ||
Post-operative renal colic | I | – | 2 |
Haematuria | I | 9 | 36 |
UTI/pyelonephritis | I | 4 | 72 |
Mild fever/pyrexia post-operatively | I | 12 | 34 |
Urinary retention | I | 1 | 8 |
Post-operative renal colic | I | – | 29 |
Re-admission due to nausea and vomiting | I | – | 1 |
Urethral stone | I | – | 1 |
Late ureterovesical junction obstruction | III | – | 5 |
Stent migration | III | 1 | 8 |
Ureteral strictures | III | – | 1 |
Post-operative ureteral stone | III | – | – |
Broken catheter | III | – | 1 |
Intra-operative bleeding/false passage/ureteral perforation/tear/laceration/submucosal wire | III | 10 | 63 |
Stone migration | III | – | 8 |
Total | – | 37 | 269 |