title: The effectiveness of 4.5F ultrathin semirigid ureteroscope in the management of ureteral stones in prepubertal children: is there a need for any ureteral dilatation?
abstract: OBJECTIVE
  To evaluate the effectiveness of 4.5F ultrathin semirigid ureteroscope (ultrathin-URS) in the management of ureteral stones in prepubertal children without active or passive ureteral dilatation.
  
  
  METHODS
  Records of 36 children undergoing ureteroscopy with ultrathin-URS were retrospectively reviewed in 2 different centers for ureteral calculi between November 2011 and December 2013. Stones were fragmented with holmium:yttrium-aluminum-garnet laser and pneumatic lithotripter. Patients' demographics, stone location and size, active dilatation, passive dilatation, postoperative stenting, stone-free rates, and complications were noted.
  
  
  RESULTS
  Patients consisted of 21 girls and 15 boys with a mean age of 5.33±3 years. Stones were located in the distal, mid, and proximal ureter in 26, 5, and 5 patients, respectively. All ureteroscopies were performed with no active or passive dilatation. Ultrathin-URS was able to provide a stone-free status in the first procedure except 1 patient whose stone was too proximal. Postoperative ureteral stents (post-stenting) had initially been placed in 16 procedures at the end of the procedure to maintain the ureteral passage. However, after increasing occupational experience and learning that ureteral traumas were minimal with ultrathin-URS, no postoperative stent was used in the following procedures. As to complications, only 3 patients had mild hematuria, and 1 patient had febrile urinary tract infection, and 1 stone migration. No ureteral perforation, obstruction and avulsion were encountered.
  
  
  CONCLUSIONS
  In ureteral stone management, ultrathin-URS along with either holmium:yttrium-aluminum-garnet laser or pneumatic lithotripter can be safely and effectively used with a minimal morbidity as a first-line treatment in prepubertal children without active or passive ureteral dilatation and postoperative stenting.
authors.affiliation: Department of Pediatric Surgery, Konya Education and Research Hospital, Konya, Turkey. Electronic address: drckocaoglu@hotmail.com.
authors.forename: Canan
authors.initials: C
authors.lastname: Kocaoglu
authors.affiliation: Division of Pediatric Urology, Department of Pediatric Surgery, Medical Faculty, Sutcu Imam University, Kahramanmaras, Turkey.
authors.forename: Keramettin Ugur
authors.initials: KU
authors.lastname: Ozkan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004106:Dilatation; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D014514:Ureteral Calculi / Q000601:surgery*; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000379:methods*