title: Ureteroscopy in pediatric patients with spinal abnormalities.
abstract: OBJECTIVE
  Ureteroscopy (URS) is considered a safe and effective treatment modality for ureteral stones in the pediatric population. Patients with scoliosis or spinal hardware, however, may have anatomic variability that makes URS challenging because of ureteral deviation or tortuosity. 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 URS were performed for purposes other than stone disease (gross hematuria, filling defects, or encrusted ureteral stents). The remainder of URS (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 URS performed for stones in normal anatomy patients, the stone-free rate was 61%, compared with 35.7% in patients with spinal deformities. There were 13 total complications (Satava grade I or II): 40% in spinal deformity patients compared with 6.1% in normal anatomy patients.
  
  
  CONCLUSIONS
  Spinal hardware and spinal deformities contribute to increased complications and worsened stone-free rates during pediatric URS compared with pediatric patients with normal anatomy. Our experience with URS 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 used as a primary modality.
authors.affiliation: Department of Urology, University of California-San Diego, CA 92103, USA.
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Colangelo
authors.forename: George
authors.initials: G
authors.lastname: Kaplan
authors.forename: Kerrin
authors.initials: K
authors.lastname: Palazzi
authors.forename: Nicholas
authors.initials: N
authors.lastname: Holmes
authors.forename: George
authors.initials: G
authors.lastname: Chiang
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D009984:Orthopedic Fixation Devices; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications*; D013131:Spine / Q000002:abnormalities*; D014514:Ureteral Calculi / Q000150:complications* / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*