ORIGINAL ARTICLE Ureteroscopic stone management in prepubertal children Ashish C. Koura Indupur R. Ravish Shrishailesh Amarkhed Rajendra B. Nerli Mallikarjun Reddy Accepted: 21 August 2007 / Published online: 20 September 2007 Ó Springer-Verlag 2007 Abstract Ureteroscopy for treating ureteric stones in prepubertal children has become more common with the advent of smaller endoscopes. We retrospectively reviewed our experience with ureteroscopy for ureteric stone in this cohort of patients. During the period Jan 2001 and June 2005, we performed 22 ureteroscopic procedures in 20 children. Ureteroscopy was done in a manner similar to that in adults. Ureteral dilatation was done in all cases. A stent was placed postoperatively if there was significant stone burden, ureteral trauma, impaction and edema of ureteric orifice. Of the 20 children, 18 were male and 2 were females. Average age was 5.2 years (range 3–9). Stones were 4–14 mm in size (average 6 mm). Overall 90% of the children were rendered stone free after one procedure and 100% after two procedures. Ureteroscopy for ureteric stones in prepubertal children is safe and effective first line treatment in whom conservative therapy fails. Routine ureteral stent placement postoperatively is not always necessary. Keywords Pediatric ureteroscopy Á Ureteric calculi Á Stents Á Dilatation Introduction The incidence of urolithiasis in the pediatric population is on the rise. Although once considered a rarity, it is now evident that children develop urinary tract stones and do so with an increasing frequency. Although many opinions exist regarding the management of the pediatric patient who presents with a stone, few would disagree that any patient who has surgically active, metabolically active, and/or infected stones should have the stones removed expeditiously. With the development of small diameter endoscopes, refinements in the techniques of lithotripsy, and age and size appropriate ancillary equipment, endoscopic litho- tripsy in children has gradually become a major technique for the treatment of urinary stones. Urolithiasis is the most common indication for ureteroscopy in children, and despite its acceptance as a mode of treatment of ureteral stones in children, there is a relative paucity of published series evaluating ureteroscopy in young children.We report our experience with ureteroscopic stone management in prepubertal (up to 10 years) children. Materials and methods We retrospectively reviewed the records of all children younger than 10 years who underwent ureteroscopy at our institution between Jan 2001 and June 2005.Patient demographics, indications for surgery, operative technique, surgical outcomes and complications were recorded. All children underwent appropriate preoperative evaluation with abdominal ultrasonography and excretory urography. Radioisotope renography and/or computerized tomography were done if needed. All ureteroscopic procedures were performed under general anesthesia. An initial cystoscopy was done with a 10 Fr Storz cystoscope. A working guide wire was placed and negotiated beyond the level of the stone. The lower ureter was dilated up to 9 Fr using Teflon dilators. A 6/7.5 Fr rigid/semi rigid ureteroscope was used in all cases, A. C. Koura (&) Á I. R. Ravish Á S. Amarkhed Á R. B. Nerli Á M. Reddy Kle Hospital, Belgaum, Karnataka, India e-mail: drashishkoura@yahoo.co.in 123 Pediatr Surg Int (2007) 23:1123–1126 DOI 10.1007/s00383-007-2012-9