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A PROSPECTIVE COMPARATIVE ANALYSIS BETWEEN
EMERGENCY AND ELECTIVE URETEROSCOPY
FOR ACUTELY OBSTRUCTING URETERAL STONES
IN CHILDREN
Ahmed FAHMY, Mohamed YOUSSIF, Haytham BADAWAY, Walid DAWOUD
and Samir ORABI
Alexandria University, Urology Department, Alexandria, EGYPT
PURPOSE
Emergency ureteroscopy for acutely obstructing ureteral stone in children offer the advantages of
immediate stone fragmentation, relief of patient’s pain and parents’ anxiety. The aim of this study is
to evaluate the safety and efficacy of the emergency ureteroscopic management of ureteral stones
immediately after a first attack of renal colic in children.
MATERIAL AND METHODS
Sixty children were prospectively randomized between two groups; group 1 (n= 30 patients) who
underwent emergency ureteroscopy within 24 hours of admission to emergency department and
group 2 (n= 30) who underwent elective ureteroscopy more than 2 weeks after the attack.
Unfavorable endoscopic appearance of the ureter including; mucosal hyperemia, edema, inflam-
matory polys and tight ureteric rings were reported in both groups. We compared stone-free rate,
operative time, incidence of complications during and after ureteroscopy and the length of postop-
erative stay between both groups.
RESULTS
Unfavorable endoscopic appearance of the ureter was more prevalent in group 1 (40% vs 13.3%)
No significant difference in stone free rate (83.3 vs 90%) were observed between both groups.
However, intraoperative complication were significantly higher in group 1 (perforation with mild
extravasation in 2 pts, postoperative hematuria in 4 pts , one case of febrile UTI) versus one case
of hematuria and another case of febrile UTI in group 2. Postoperative stay was significantly longer
in group 1 compared to group 2 (2.2 days vs 1.4 days).
CONCLUSIONS
Emergency ureteroscopy is not recommended in case of acutely obstructing ureteric stone in chil-
dren. Elective ureteroscopy has a lower morbidity with the potential advantage of allowing ample
time for clearing of infection, inflammation and theoretical possibility of spontaneous stone passage.