title: When is prior ureteral stent placement necessary to access the upper urinary tract in prepubertal children?
abstract: OBJECTIVE
  We studied the possibility that age, height, weight and body mass index could be used to predict the likelihood of successful ureteroscopic access to the upper urinary tract without previous stent placement in prepubertal children.
  
  
  METHODS
  We retrospectively reviewed all ureteroscopic procedures for upper tract calculi in prepubertal children from 2003 to 2007. We compared age, height, weight and body mass index in patients who underwent successful primary flexible ureteroscopic access and in those who required initial stent placement to perform ureteroscopy.
  
  
  RESULTS
  Successful primary ureteroscopic access to the upper tract was achieved in 18 of 30 patients (60%). There was no difference in mean age (9.9 vs 9.5 years, p = 0.8), height (132 vs 128 cm, p = 0.6), weight (37 vs 36 kg, p = 0.86) or body mass index (19.3 vs 20.5 kg/m(2), p = 0.55) between patients with successful vs unsuccessful upper tract access. Locations that prevented access to the upper urinary tract were evenly distributed among the ureteral orifice, iliac vessels and ureteropelvic junction.
  
  
  CONCLUSIONS
  Age, height, weight and body mass index could not predict the likelihood of successful ureteroscopic access to the upper tract. Placement of a ureteral stent for passive ureteral dilation is not necessary for successful ureteroscopic access to the renal pelvis in prepubertal children. An initial attempt at ureteroscopy, with placement of a ureteral stent if upper tract access is unsuccessful, decreases the number of procedures while maintaining a low complication rate.
authors: Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213-3232, USA. corcoranat@upmc.edu
authors: Anthony T
authors: AT
authors: Corcoran
authors: Marc C
authors: MC
authors: Smaldone
authors: Dev
authors: D
authors: Mally
authors: Michael C
authors: MC
authors: Ost
authors: Mark F
authors: MF
authors: Bellinger
authors: Francis X
authors: FX
authors: Schneck
authors: Steven G
authors: SG
authors: Docimo
authors: Hsi-Yang
authors: HY
authors: Wu
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy; D004106:Dilatation; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D014514:Ureteral Calculi / Q000601:surgery*; D018666:Ureteroscopy