title: [Impact of the acquisition of a flexible ureteroscope on the management of upper urinary tract stones in children].
abstract: BACKGROUND
  Firstly reported in the early 1990s for the treatment of upper urinary tract stones in adult patients, flexible ureteroscopy (F-URS) has been used in children during the past 10 years and is now considered as a viable, but still second-line alternative to extracorporeal shockwave lithotripsy in these patients (ESWL). The aim of this study was to assess the impact of the acquisition of a F-URS on the management of upper urinary tract stones in children.
  
  
  METHODS
  Data of all ESWL, F-URS and percutaneous nephrolithotomy performed for upper urinary tract stones in children from 0 to 18 years old in a single center from 2000 to 2014 have been collected retrospectively. Patients have been divided into two groups: group 1 before the acquisition of the F-URS (2000-2008) and group 2 after the acquisition of the F-URS (2008-2014). Preoperative data and peri-operative outcomes were compared between both groups using the χ(2) test and Fisher exact test for discrete variables and the Mann-Whitney test for continuous variables.
  
  
  RESULTS
  Thirty-seven children have been treated during the first era and 32 during the second one. The two groups were similar in terms of age (7.2 years vs 8.1 years; P=0.54), size of the largest stone (15 mm vs 16.2mm; P=0,56) and number of stones per patient (1.4 vs 2; P=0,07) but the sum of stone diameters was higher in group 2 (16.9 mm vs 24.2mm; P=0,048). The stone-free rates were comparable in both groups (28.1% vs 32.2% after the first procedure; P=0.72), as were the mean number of procedures per patient (2.4 vs 2.5; P=0.78), the total length of stay (2.7 days vs 2.9 days; P=0.77), and the number of patients who experienced at least one complication (37.8% vs 40.6%; P=0.87).
  
  
  CONCLUSIONS
  The acquisition of a F-URS allowed the treatment of more complex stones with a similar efficacy and without increasing morbidity. Further studies are needed to define the role of F-URS in the management of upper urinary tract stones in children.
authors.affiliation: Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France. Electronic address: lauranne.26@live.fr.
authors.forename: L
authors.initials: L
authors.lastname: Tondut
authors.affiliation: Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
authors.forename: B
authors.initials: B
authors.lastname: Peyronnet
authors.affiliation: Service de chirurgie pédiatrique, CHU de Rennes, 35000 Rennes, France.
authors.forename: A
authors.initials: A
authors.lastname: Arnaud
authors.affiliation: Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
authors.forename: L
authors.initials: L
authors.lastname: Freton
authors.affiliation: Service de chirurgie pédiatrique, CHU de Rennes, 35000 Rennes, France.
authors.forename: J
authors.initials: J
authors.lastname: Hascoet
authors.affiliation: Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
authors.forename: B
authors.initials: B
authors.lastname: Pradère
authors.affiliation: Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
authors.forename: G
authors.initials: G
authors.lastname: Berquet
authors.affiliation: Service de chirurgie pédiatrique, CHU de Rennes, 35000 Rennes, France.
authors.forename: E
authors.initials: E
authors.lastname: Habonimana
authors.affiliation: Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
authors.forename: G
authors.initials: G
authors.lastname: Verhoest
authors.affiliation: Service de chirurgie pédiatrique, CHU de Rennes, 35000 Rennes, France.
authors.forename: O
authors.initials: O
authors.lastname: Azzis
authors.affiliation: Service de chirurgie pédiatrique, CHU de Rennes, 35000 Rennes, France.
authors.forename: B
authors.initials: B
authors.lastname: Fremond
authors.affiliation: Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
authors.forename: K
authors.initials: K
authors.lastname: Bensalah
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D006801:Humans; D007223:Infant; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy; D012189:Retrospective Studies; D014514:Ureteral Calculi / Q000628:therapy*; D020709:Ureteroscopes / Q000706:statistics & numerical data*
keywords: Calculs; Children; Enfants; Extracorporeal shockwave lithotripsy; Flexible ureteroscopy; Lithiasis; Lithotripsie extra-corporelle; Néphrolithotomie percutanée; Percutaneous nephrolithotomy; Urétéroscopie souple