Objective: To specify the characteristics of symptomatic ureteric stones in children and to define therapeutic indications for these stones.
Material and methods: Between 1993 and 2000, 24 children were treated for obstructive ureteric stones. The assessment comprised ultrasound and plain x-ray of the abdomen. A metabolic work-up and cystography +/- IVU were performed secondarily. First-line treatment consisted of medical treatment only in 34% of cases (8/24), piezoelectric extracorporeal lithotripsy (ESWL) (EDAP LT02) in 58% of cases (14/24) and ureteroscopy with ballistic fragmentation in 8% of cases (2/24).
Results: This series consisted of 15 boys and 9 girls with a mean age of 6 years (range: 1 month to 15 years). The most frequent presenting complaints were renal colic in 14 cases and acute pyelonephritis in 7 cases. The obstructive ureteric stone was associated with urinary tract infection in 1/3 of cases. 12 children had a single stone and 12 children had multiple stones. The stone was situated in the pelvic ureter in 15 cases, the iliac ureter in 4 cases, and the lumbar ureter in 6 cases. The aetiological survey revealed hypercalciuria in 6 cases, cystinuria in 2 cases, and 4 urinary tract malformations. In 34% of cases (8/24), the stone was eliminated spontaneously (phi < or = 5 mm). 78% (11/14) of stones treated by ESWL (14/24) (mean phi = 8.3 mm) left no residual fragments with this treatment alone. The re-treatment rate was 36% (4/11). Three failures of ESWL were treated by ureteroscopy in 2 cases and surgery in 1 case. 92% (22/24) of these children were stone-free with a mean follow-up of 16 months.
Discussion: Obstructive ureteric stones in children are associated with a high risk of infectious complications, justifying rapid and appropriate treatment. A metabolic abnormality must always be investigated and is present in 1/3 of cases. A stone diameter of 5 mm corresponds to the upper limit allowing spontaneous elimination during medical treatment. ESWL is the treatment of choice for ureteric stones greater than 5 mm in diameter, especially in the pelvic ureter. Ureteroscopy can be performed in children after failure of ESWL and for complicated stones.