Retrograde Intrarenal Surgery (RIRS) for upper urinary tract stones in children below 12 years of age: A single centre experience
https://doi.org/10.4081/aiua.2022.2.190
Accepted: May 20, 2022
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Objective: Retrograde Intra Renal Surgery (RIRS) is a minimally invasive surgical modality for the treatment of renal stones. We evaluated the efficacy of RIRS in children below aged 12 years of age in the form of stone-free rate (SFR), complications and the feasibility of the procedure. Materials and methods: This retrospective study included all children ≤ 12 years of age, with upper urinary tract stones single or multiple ≤ 15 mm in size who underwent RIRS between February 2019 to November 2021. RIRS was performed with 7.5 Fr flexible ureterorenoscope over the guidewire, the stones were dusted with Laser and the ureteral stent was left after RIRS. All patients had the post-procedure stent removed within 3 weeks after checking for residual stones with X-ray and ultrasonography of Kidney-Ureter-Bladder (USG-KUB). Follow-up USG KUB was done at 4 months. Results: 15 patients included in our study met the inclusion criteria. The mean age was 8.7 ± 2.8 years, the mean stone size was 11.26 ± 2.14 mm and 26.6 % had multiple stones. Retrograde access failure was noted in 36.3 % in non stented patients. The mean operative time was 72.6 ± 20 minutes, fluoroscopy time was 4.4 ± 0.9 minutes and the mean LASER time was 26 ± 3.9 minutes. The mean hospital stay was 2.8 ± 0.9 days. Ureteral access sheath (UAS) was used in one patient. Conversion to mini PCNL was done in one pre stented patient due to access failure and one patient had a second look RIRS for residual stone. No major complications were noted except onr patient who had sepsis. The stone-free rates were 93.3% after primary RIRS and 100% after second look RIRS. Conclusions: RIRS is a feasible, safe procedure for pediatric upper urinary stones with excellent stone-free rates and a low rate of complications.
Clayton DB, Pope JC. The increasing pediatric stone disease problem. Ther Adv Urol 2011; 3:3-12. DOI: https://doi.org/10.1177/1756287211400491
Copelovitch L. Urolithiasis in children: medical approach. Pediatr Clin North Am 2012; 59:881-96. DOI: https://doi.org/10.1016/j.pcl.2012.05.009
EAU-Guidelines-on-Paediatric-Urology-2022.pdf. https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelineson-Paediatric-Urology-2022.pdf
Ferretti S, Cuschera M, Campobasso D, et al. Rigid and flexible ureteroscopy (URS/RIRS) management of paediatric urolithiasis in a not endemic country. Arch Ital Urol Androl. 2021; 93:26-30. DOI: https://doi.org/10.4081/aiua.2021.1.26
Muslumanoglu AY, Tefekli A, Sarilar O, et al. Extracorporeal shock wave lithotripsy as first line treatment alternative for urinary tract stones in children: a large scale retrospective analysis. J Urol. 2003; 170:2405-8. DOI: https://doi.org/10.1097/01.ju.0000096422.72846.80
Unsal A, Resorlu B, Kara C, et al. Safety and efficacy of percutaneous nephrolithotomy in infants, preschool age, and older children with different sizes of instruments. Urology. 2010; 76:247-52. DOI: https://doi.org/10.1016/j.urology.2009.08.087
Ishii H, Griffin S, Somani BK. Flexible ureteroscopy and lasertripsy (FURSL) for paediatric renal calculi: results from a systematic review. J Pediatr Urol. 2014; 10:1020-5. DOI: https://doi.org/10.1016/j.jpurol.2014.08.003
Kim SS, Kolon TF, Canter D, et al. Pediatric flexible ureteroscopic lithotripsy: the children's hospital of Philadelphia experience. J Urol. 2008; 180:2616-9. DOI: https://doi.org/10.1016/j.juro.2008.08.051
Unsal A, Resorlu B. Retrograde intrarenal surgery in infants and preschool-age children. J Pediatr Surg. 2011; 46:2195-9. DOI: https://doi.org/10.1016/j.jpedsurg.2011.07.013
Chandramohan V, Siddalingaswamy PM, Ramakrishna P, et al. Retrograde intrarenal surgery for renal stones in children < 5 years of age. Indian J Urol 2021; 37:48-53. DOI: https://doi.org/10.4103/iju.IJU_53_21
Corcoran AT, Smaldone MC, Mally D, et al. When is prior ureteral stent placement necessary to access the upper urinary tract in prepubertal children? J Urol. 2008; 180(4 Suppl):1861-3. DOI: https://doi.org/10.1016/j.juro.2008.03.106
Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol. 2013; 189:580-4. DOI: https://doi.org/10.1016/j.juro.2012.08.197
Anbarasan R, Griffin SJ, Somani BK. Outcomes and long-term follow-up with the use of ureteral access sheath for pediatric ureteroscopy and stone treatment: results from a tertiary endourology center. J Endourol. 2019;33:79-83. DOI: https://doi.org/10.1089/end.2018.0448
Berrettini A, Boeri L, Montanari E, et al. Retrograde intrarenal surgery using ureteral access sheaths is a safe and effective treatment for renal stones in children weighing < 20 kg. J Pediatr Urol. 2018; 14:59.e1-59.e6. DOI: https://doi.org/10.1016/j.jpurol.2017.09.011
Mosquera L, Pietropaolo A, Brewin A, et al. Safety and Outcomes of using ureteric access sheath (UAS) for treatment of Pediatric renal stones: Outcomes from 2 tertiary endourology centers. Urology. 2021; 157:222-226. DOI: https://doi.org/10.1016/j.urology.2021.04.011
Chen Y, Deng T, Duan X, et al. Percutaneous nephrolithotomy versus retrograde intrarenal surgery for pediatric patients with upper urinary stones: a systematic review and meta-analysis. Urolithiasis. 2019; 47:189-199. DOI: https://doi.org/10.1007/s00240-018-1039-9
Bas¸ O, Dede O, Aydogmus Y, et al. Comparison of retrograde intrarenal surgery and micro-percutaneous nephrolithotomy in moderately sized pediatric kidney stones. J Endourol. 2016; 30:765-70. DOI: https://doi.org/10.1089/end.2016.0043
Saad KS, Youssif ME, Al Islam Nafis Hamdy S, et al. Percutaneous nephrolithotomy vs retrograde intrarenal surgery for large renal stones in pediatric patients: a randomized controlled trial. J Urol. 2015; 194:1716-20. DOI: https://doi.org/10.1016/j.juro.2015.06.101
Mokhless IA, Abdeldaeim HM, Saad A, Zahran AR. Retrograde intrarenal surgery monotherapy versus shock wave lithotripsy for stones 10 to 20 mm in preschool children: a prospective, randomized study. J Urol. 2014; 191(5 Suppl):1496-9. DOI: https://doi.org/10.1016/j.juro.2013.08.079
Ergin G, Kirac M, Kopru B, et al. Shock wave lithotripsy or retrograde intrarenal surgery: which one is more effective for 10-20-mm renal stones in children. Ir J Med Sci. 2018; 187:1121-1126. DOI: https://doi.org/10.1007/s11845-018-1776-3
He Qing, Xiao K, Chen Y, et al. Which is the best treatment of pediatric upper urinary tract stones among extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery: a systematic review. BMC Urol. 2019; 19:98. DOI: https://doi.org/10.1186/s12894-019-0520-2
Mosquera L, Pietropaolo A, Madarriaga YQ, et al. Is flexible ureteroscopy and laser lithotripsy the new gold standard for pediatric lower pole stones? Outcomes from two large European tertiary pediatric endourology centers. J Endourol. 2021; 35:1479-1482. DOI: https://doi.org/10.1089/end.2020.1123
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
