Ureteroscopy for Kidney Stones in Children

Children’s Hospital of Philadelphia’s Pediatric Kidney Stone Center offers ureteroscopy to remove kidney stones. www.chop.edu/kidneystonecenter

In this video:
[0:12] Aman’s kidney stone diagnosis
[1:05] Common symptoms of pediatric kidney stones
[1:35] Importance of partnering with patients and caregivers
[2:05] Treatment options for kidney stone removal
[2:18] What is ureteroscopy?
[3:15] What is a ureteral stent?
[3:53] Aman’s experience with ureteroscopy
[4:24] Importance of kidney stone prevention and research
[5:00] Aman’s outlook on the future

In this video, 17-year-old Aman discusses his experience with kidney stones and what it was like to undergo ureteroscopy surgery at Children’s Hospital of Philadelphia (CHOP).

Normally, urine contains many dissolved materials. If these materials become concentrated in the urine, they can form solid crystals that can lead to the development of small, hard deposits of minerals (called kidney stones) that can form inside the kidneys or ureter (the tube that connects the kidney to the bladder).

Kidney stone disease (also called nephrolithiasis) can cause blood in the urine, pain, nausea, vomiting and fever and block the drainage of urine. Kidney stones are associated with a higher risk of high blood pressure, heart disease, loss of kidney function, and lower bone mineral density leading to fractures.

Kidney stones are becoming more common in children. The likelihood that a child will develop a kidney stone has doubled over the last 25 years. Until recently, children with kidney stones were primarily treated in adult healthcare settings. Studies have shown, however, that specialized care for children with stones improves patient outcomes.

In 2014, to meet the rising need for specialized kidney stone treatment for children, Children’s Hospital of Philadelphia (CHOP) established the Pediatric Kidney Stone Center. The center offers integrated, state-of-the-art care for infants, children, adolescents, and young adults with kidney stone disease. It offers access to the leading specialists in the world in diagnosing, evaluating and treating stones, medically, surgically and through diet.

The center uses a multidisciplinary approach that includes pediatric urologists, pediatric nephrologists, radiologists, emergency room physicians, nurse practitioners, physician's assistants, nurses, and dietitians.

The center offers three treatment options: lithotripsy, ureteroscopy and percutaneous nephrolithotomy (PCNL). This video takes an in-depth look at ureteroscopy. It includes a detailed account from Aman about his experience undergoing the procedure, and expert insight from pediatric urologist Gregory Tasian, MD, co-director of the center.

Ureteroscopy is a minimally invasive procedure, in which there are no incisions, It is typically done for small to medium-sized stones. A very small scope, called a ureteroscope, is inserted into the ureter to visualize the kidney stone. The urologist can then visualize the kidney stone in real-time on a monitor and uses a laser to break the stone up into very small particles that can be passed spontaneously in the urine.

Some stone fragments are extracted and sent to a lab for analysis. Knowing the stone’s composition is critical to understanding what type of stone it is and informing what measures can be used to prevent the stone from coming back.

After the ureteroscopy, a thin plastic tube called a ureteral stent may be needed. The stent is placed in the kidney leading to the bladder to allow urine to drain into the bladder while the child’s body heals from any swelling and inflammation caused by the stone and the procedure itself. The stent may be left in the kidney anywhere from a few days to a few weeks.

Ureteroscopy is an outpatient procedure. In most cases, a child can go home after recovering for about an hour or two.

The team explains the treatment options — including the likelihood of each completely clearing the stone and the surgical and postsurgical experience — and then partners with families to help them make the most informed decision possible.

In addition to removing existing stones, the center’s team tries to prevent future kidney stones. Patients return for follow-up every six months for metabolic testing and an ultrasound to help the team understand what factors are driving stone formation.

The center team is involved in ongoing research efforts dedicated to better understanding why kidney stones are occurring earlier in life and the factors that lead to kidney stones in children. Their hope is to develop better methods to prevent stones from being a recurring disease over a lifespan and improve treatment options for children with kidney stones.

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