Is Flexible Ureteroscopy and Laser Lithotripsy the New Gold Standard for Pediatric Lower Pole Stones? Outcomes from Two Large European Tertiary Pediatric Endourology Centers

Mosquera, Lucía; Pietropaolo, Amelia; Madarriaga, Yesica Quiroz; Llorens, Erika; Jones, Patrick; Bujons, Anna; Griffin, Stephen; Somani, Bhaskar K.

doi:10.1089/end.2020.1123

Cited by 13 publications

(15 citation statements)

References 21 publications

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“…In a study evaluating 57 paediatric patients with lower pole stones (mean age 10.1 years), the authors demonstrated 82 and 98% initial and final SFR with RIRS (1.9 procedures/patient). They reported no intraoperative complications and 7% minor postoperative complications [24].…”

Section: Methodsmentioning

confidence: 94%

Paediatric stone management: innovations and standards

Quhal

Faddagh

Sılay³

et al. 2022

Current Opinion in Urology

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Purpose of reviewThe aim of this study was to discuss current trends and recent developments in the surgical management of paediatric urolithiasis. Recent findingsMedical expulsive therapy (MET) is considered as an option for the treatment of children with ureter stones. Extracorporeal shockwave lithotripsy (SWL) remains as a first option for majority of kidney stones and upper ureter stones. Advances in endourology have led to increased adoption of retrograde intrarenal surgeries (RIRS) and percutaneous nephrolithotomy (PCNL/mini-PCNL/ultra-mini-PCNL/micro-PCNL).

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Section: Methodsmentioning

confidence: 94%

Paediatric stone management: innovations and standards

Quhal

Faddagh

Sılay³

et al. 2022

Current Opinion in Urology

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“…There was no major post-operative complication in our study, only one patient had sepsis requiring high dose antibiotics and a longer hospital stay. Mosquera et al (22) reviewed the data of 57 children who underwent FURSL for lower pole stones from two large European tertiary endourology centers and reported initial and final stonefree rates of 82.4% and 98.2% respectively; 1.19 procedures per patient were required to be stone free. Despite the advantages of RIRS, there are certain drawbacks associated with this procedure.…”

Section: Discussionmentioning

confidence: 99%

Retrograde Intrarenal Surgery (RIRS) for upper urinary tract stones in children below 12 years of age: A single centre experience

Thangavelu

Sawant

Sayed

et al. 2022

Arch Ital Urol Androl

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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 & 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.

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“…Procedural details have previously been extensively detailed and discussed. 7 – 9 Stone diagnosis was established by ultrasound scan or plain KUB XR and during follow-up, a renal USS (Ultrasound Scan) was done to confirm the stone-free status. A multidisciplinary team (MDT) discussed all cases.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of ureteroscopy for management of stone disease in early and late childhood over a 15-year period

Mani

Pietropaolo

Madarriaga

et al. 2022

Therapeutic Advances in Urology

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Background: Although paediatric ureteroscopy is widely performed, there is still a lack of data and outcomes in early childhood. In this two-centre study, we compared the outcomes of ureteroscopy for stone disease management in early and late childhood and provide outcomes for the same. Methods: Data was retrospectively collected on consecutive patients from two tertiary paediatric endo-urology European centres over a 15-year period (2006–2021). Patients were split into two groups, namely, early childhood (age ⩽ 9 years) and late childhood (age 9 to ⩽16 years). Outcomes including stone-free rate (SFR) and complications were compared between these two groups. Results: A total of 148 patients underwent 184 procedures (1.2 procedure/patient) during the study period (66 in early childhood and 82 in late childhood). The mean age in early and late childhood groups were 5.6 and 13.3 years, and a male: female ratio of 1.6:1 and 1.1:1, respectively. The SFR and complications in early and late childhood groups were 87.8% and 90.2% ( p = 0.64) and 5.7% and 4.1%, respectively. Conclusion: Paediatric ureteroscopy and laser stone fragmentation achieves good results in both early and late childhood with comparable SFRs, although the complications and need for second procedure were marginally higher in the early childhood group. Our study would set up a new benchmark for patient counselling in future, and perhaps this needs to be reflected in the paediatric urolithiasis guidelines.

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Is Flexible Ureteroscopy and Laser Lithotripsy the New Gold Standard for Pediatric Lower Pole Stones? Outcomes from Two Large European Tertiary Pediatric Endourology Centers

Cited by 13 publications

References 21 publications

Paediatric stone management: innovations and standards

Paediatric stone management: innovations and standards

Retrograde Intrarenal Surgery (RIRS) for upper urinary tract stones in children below 12 years of age: A single centre experience

Outcomes of ureteroscopy for management of stone disease in early and late childhood over a 15-year period

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