Is Retrograde Intrarenal Surgery as Safe for Children as It Is for Adults?

Abstract

<b><i>Introduction:</i></b> The primary aim of this study is to compare the efficacy and safety of retrograde intrarenal surgery (RIRS) among the children and adults with similar stone burdens and locations. Also, the secondary aim of this study is to identify the factors affecting the stone-free rates (SFRs) of RIRS. <b><i>Methods:</i></b> We retrospectively compared perioperative results, SFRs, and complication rates (CRs) between pediatric (group 1, <i>n</i>: 55) and adult (group 2, <i>n</i>: 220) age groups diagnosed with kidney stones and treated by flexible ureterorenoscopy using the same instruments. Furthermore, multivariate analysis was performed to determine the factors affecting the SFR. <b><i>Results:</i></b> A total of 275 patients (pediatric group: 55; adult group: 220) were included in this study. The mean age of pediatric and adult groups was 7.2 ± 5.3 and 43.9 ± 15.1, respectively. The mean stone size was 13.9 ± 6.6 mm in the pediatric group compared to 14.8 ± 6.7 mm in the adult group (<i>p</i> = 0.35). Stone localizations and number were similar. JJ stenting for passive dilatation and use of UAS were higher in the pediatric group (<i>p</i> = 0.002; <i>p</i> = 0.017). However, postoperative double pigtail stenting rate was higher in the adult group (<i>p</i> < 0.001). Total CR was 13.8% and mostly Clavien I–II, and no difference was observed between the 2 groups (<i>p</i> = 0.541). The SFRs between the groups were similar (pediatric group: 81.8%; adult group: 78.2%; <i>p</i> = 0.554). On multivariate analysis, stone size (<i>p</i> < 0.001) and lower calyx stone (<i>p</i> < 0.001) were the negative predictive factors for SFR. <b><i>Conclusion:</i></b> There are small technical differences between pediatric patients and adult patients in our study, but RIRS in children is as safe and efficient as it is in adults.

Role of Pediatric Ureteral Access Sheath and Outcomes Related to Flexible Ureteroscopy and Laser Stone Fragmentation: A Systematic Review of Literature

“…One study [30] did not report UAS caliber. UAS length was specified only in nine out of 22 studies, with four groups using a 35 cm UAS [13] , [20] , [22] , [31] , two using either a 20 or a 28 cm UAS [21] , [32] , one using a 28 cm UAS only [19] , one using either a 20 or a 35 cm UAS [18] , and one using either a 28 or a 35 cm UAS [24] .…”

“…Eighteen articles reported data on the postoperative placement of a ureteric stent. Great heterogeneity emerged, with three groups [18] , [19] , [32] choosing to insert a stent in every patient (either a ureteral catheter or a JJ stent) and two groups [13] , [30] in >90% of patients, compared with three groups [15] , [31] , [33] that put a stent in <50% of patients. Four studies [14] , [17] , [23] , [34] did not report data on postoperative stent placement.…”

Ureteroscopy for stone disease in the paediatric population: lessons learned and outcomes in a Nordic setting

“…Turkey) or it is non-endemic, but the population is large, for example, the United States. 8 , 9 , 17 – 20 , 23 Furthermore, the procedures in these reports are usually, but not always, performed by paediatric endourologists. Figures 1 and 2 display number of publications (as per PubMed) of original series between 2000 and 2020.…”

“… 12 – 16 Most published reports originate from a relatively small pool of nations with large population sizes ( Figures 1 and 2 ). 8 , 9 , 17 – 20 Outcomes from smaller nations remain under-reported.…”

“…6 This shift in the role of URS is largely due to the increasing number of original series, which demonstrate that its safety profile in the setting of this non-indexed patient group has ameliorated in recent years. [7][8][9] This has been facilitated as a result of increased surgical experience, introduction of newer laser platforms and new technologies, such as next-generation ureteroscopes. 10,11 There exist a range of practice patterns and areas of debate in paediatric URS, such as the role of elective and planned pre-operative stenting prior to definitive stone treatment, use of ureteral access sheath (UAS) and optimal followup regimes.…”