Endoscopic treatment of ureteral stones in children: efficacy, safety, and analysis of infectious-inflammatory complications

Endoscopic techniques are increasingly used for ureteral stones in children, but data on their safety and on the determinants of postoperative infectious-inflammatory complications (IIC) in the pediatric population remain limited. This study aimed to evaluate the efficacy and safety of endoscopic treatment of ureteral stones in children and to analyze the frequency, severity, and correlates of IIC. We analyzed 85 children (aged 4–17 years) who underwent endoscopic treatment of ureteral stones at a single tertiary urology center; the pediatric cohort was assessed separately from adults because of anatomical and physiological differences, and demographic, stone-related, infection-related, and procedural variables were compared between children with and without IIC using univariate methods, with no multivariable modeling undertaken given the small number of complicated cases. The immediate stone-free rate was 98.8% (84/85), with a single residual stone that did not require reintervention; most stones were small (≤ 5 mm in 90.6%) and located in the distal ureter (54.1%), and treatment was delivered mainly by transurethral (retrograde) ureterolithotripsy (55.3%) and percutaneous antegrade ureterolithotripsy (43.5%). IIC occurred in 12 of 85 children (14.1%) and were mild in every case, with no acute obstructive pyelonephritis or urosepsis; on univariate comparison, the only variable that differed significantly between children with and without IIC was the degree of leukocyturia (median 151,250 vs 22,500/mL; p < 0.001), whereas sex, age, stone location and size, bacteriuria, blood leukocyte count, preoperative drainage, and type of intervention did not differ significantly. Endoscopic treatment of ureteral stones in children is thus highly effective and safe, achieving a very high stone-free rate with infrequent and uniformly mild infectious complications, and the baseline infectious status of the urinary tract, reflected chiefly by leukocyturia, is the principal correlate of IIC, underscoring the importance of preoperative assessment and correction of urinary infection.