Outcomes and lessons learnt from practice of retrograde intrarenal surgery (RIRS) in a paediatric setting of various age groups: a global study across 8 centres

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

“…Overall, 1317 patients (693 males and 624 females) were included, and 1416 ureteroscopies with UAS placement were performed. Some patient cohorts were relatively small (eight patients with cystinuria submitted to multiple procedures [13] ); conversely, one article gathered data from eight different centers globally in a multicentric study [14] , collecting data from 314 pediatric patients. Two articles showed outcomes from large cohorts of patients in tertiary endourological referral centers (167 patients and 170 URS procedures [15] , and 81 patients and 102 URS procedures [16] ).…”

“…Most groups used a 9.5 or 11.5 Fr UAS (three used 9.5 Fr UAS, three 11–9.5 Fr UAS, seven 11.5–9.5 UAS, and one 10–12 Fr UAS). Seven groups [13] , [14] , [15] , [23] , [27] , [28] , [29] used different caliber access sheaths, depending on the surgeon’s choice, with calibers varying from 8 to 15 Fr. One study [30] did not report UAS caliber.…”

“…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. Stent removal was achieved after a mean of 21.5 d, with most of the groups leaving it for 10–14 d [15] , [18] , [19] , [21] , [23] , others for 21–28 d [13] , [24] , [32] or up to 6–8 wk [16] , [20] .…”

“…Intraoperative complications included: rupture of the laser fiber during lithotripsy, intrarenal bleeding, ureteral injury [13] , pelvicalyceal system or ureteric injury [14] , ureteric damage [19] , ureteral perforation with extravasation, submucosal wire, and proximal stent migration [27] , and one case of distal ureteral stricture requiring ureteral reimplantation [29] . Postoperative complications reported were the following: fever, obstructive pyelonephritis [13] , hematuria [17] , [18] , [32] , sepsis [14] , [16] , vomiting, urinary tract infection [17] , [18] , [21] , [26] , pain, urinary retention [16] , hydrocalyx [18] , ureteral wall injury [17] , postoperative hydronephrosis [27] , voiding symptoms, and rehospitalization [30] . Six studies reported no postoperative complications [15] , [20] , [22] , [23] , [25] , [28] .…”

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

“… 34 A recent global study revealed that this ancillary device was used routinely in over 50% of cases. 35 However, given the lack of long-term data and potential risks for ureteric injury, it is not part of our routine practice. 4 , 36 It is possible, however, that use of UAS could have served to reduce risk of infectious complications given this accessory can reduce intra-renal pressure.…”