Ureteroscopy for stones

Kidney stones are quite uncommon in children compared to adults. The meat of the kidney produces pee (urine) which then passes into a funnel-shaped drainage sac called the pelvis. From here the pee flows downward to the bladder along a tube called the ureter. The pee is stored in the bladder and then passed out through a tube called the urethra which is short in girls but longer in boys as it passes through the penis.

Where can stones form?

Most stones appear in the kidney with the rest happening in the ureter (the pee tube from kidney to the bladder) or the bladder.

How can stones be removed?

Urinary tract stones can be treated by an operation. These can be open surgery or keyhole surgery.

The choice depends on:

• the child’s age
• the position of the stone
• the size of the stone
• the anatomy of the urinary tract
• any other associated problems your child may have

Your child is going to have ‘percutaneous nephrolithotomy’ for their kidney stone.

What will happen before the operation?

Before the operation, your child will need blood and urine tests which can be done from the clinic. This can be done on the day of surgery or at your local hospital.

On the day before or the day of surgery, your child will need an X-ray or ultrasound of their tummy. This is to make sure where the stones are and how many there are.

You will be told about your child not being able to eat or drink before the operation.

Your child may be admitted on the day of or the day before their surgery.

What does the operation involve?

The operation is done under a general anaesthetic. It involves passing a small instrument called a ureteroscope from the front passage, through the bladder and into the ureter to see the stone.

Once the stone is seen, it can be taken out by making it smaller with a laser beam or by grabbing it in a basket. Once the stone is taken out, a little tube called a stent may be left in the bladder to prevent pieces of stone from getting stuck in the ureter. Your child may also have a catheter.

The whole procedure takes 1 to 2 hours.

What will happen after the operation?

After the operation, your child will be on an intravenous (IV) drip. They will be able to start drinking and eating within 24 hours of the surgery and then the drip will be removed. They will also be on a special drip for pain relief.

Your child will have antibiotics through the drip to begin with and then by tablets.

Your child may go home the same day or the next day. If a stent has been placed, this will be taken out under an anaesthetic in 4 to 6 weeks. The catheter will be removed the morning after surgery.

What things can go wrong with the operation?

Most operations go without any problems. Risks connected to this operation are:

• Blood in the pee is very normal and can settle without treatment.
• Injury to the wall of the ureter may need an open operation.
• Failure to pass the ureteroscope into the ureter could stop the procedure and a stent will be put in. In this case, we will try again in 4 to 6 weeks or we will remove the stone through an open operation.
• Infection is stopped with antibiotics.
• Fever can be managed paracetamol, ibruprofen (if the kidneys work okay), and may need antibiotics.
• Pee collection around the ureter due to a leak after injury to the ureter which normally stops but may need to be drained.
• Leftover or another stone.
• Blocking of the ureter with pieces of stone.
• Moving of stone from the ureter into the kidney. The stone will have to be treated by another procedure.

What will happen after leaving the hospital?

After leaving the hospital, children make a quick recovery and may return to normal activities within 2 weeks in most cases.

Your child will need to remain on antibiotics for up to a year following surgery.

Do we need to be seen after the operation?

Your child may be followed up in Sheffield or at your local hospital based on where you live and what you need. This may include an X-ray or ultrasound. More tests may be needed if anything is found.