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

Abstract

Introduction: Paediatric stone disease is rare in the Nordic communities. Still, the condition can require surgical intervention in the form of ureteroscopy (URS). Here, we report outcomes achieved at a regional (tertiary) centre. Patients and methods: Retrospective analysis was performed of consecutive patients (<18 years of age) undergoing URS for stone disease between 2010 and 2021. Outcomes of interest included stone-free rate (SFR) determined using a definition of no residual fragments ⩾ 3 mm on imaging and complications classified according to Clavien–Dindo system. Results: In total, 23 patients underwent 47 URS procedures for a total of 31 stone episodes. Mean age was 9 (range 1–17) years and male-to-female ratio was 6:17. Overall, 35% had at least one medical comorbidity. Ultrasound determined preoperative stone status in 87%. Mean largest index and cumulative stone sizes were 9 (range 3–40) and 12 (range 3–40) mm, respectively. Overall, 32% had multiple stones. Lower pole was the commonest stone location (39%). No patients underwent elective pre-operative stenting. Ureteral access sheaths were not used in any cases. Access to upper urinary tract at first procedure was successful in 94%. Initial and final SFR was 61% and 90%, respectively. No intra-operative complications were recorded. Overall post-operative complication rate was 17.5%. Urinary tract infection (CD II) was the commonest adverse event (12.5%). Conclusion: Paediatric URS can be delivered in the setting of a regional centre without compromising outcomes. This includes when carried out by adult endourologists, without routine pre-stenting and omitting use of ureteric access sheath.

Outcomes and considerations for retrograde intrarenal surgery (RIRS) in the setting of multiple and large renal stones (>15 mm) in children: Findings from multicentre and real‐world setting

“…The use of UAS was higher in Group 2, and this could have contributed to the higher complication burden in this group and in particular, the higher rate of pelvicalyceal injury. RIRS can also be a more feasible option in geographic settings where paediatric endourology may not be a defined subspeciality and such cases are performed by adult urologists 10 . In such setting, the learning curve for RIRS in children is shorter compared to PCNL 11 .…”

“…RIRS can also be a more feasible option in geographic settings where paediatric endourology may not be a defined subspeciality and such cases are performed by adult urologists. 10 In such setting, the learning curve for RIRS in children is shorter compared to PCNL. 11 Regardless of choice of RIRS or PCNL, even once the learning curve has been reached, a higher volume of paediatric cases has been found to deliver improved outcomes.…”

Worldwide trends of practice and intervention in Paediatric Endourology: Comparison of European versus Non-European responses

“…A recent original study from Norway showed how paediatric URS and RIRS can also be delivered by adult endourologists in regional cenres without outcomes being compromised [18]. The use of SWL seems to have gradually decreased over time [19], however, it does still serve as a valid option for kidney stones <2 cm and reported SFRS range between 49% and 97% [20].…”

Paediatric kidney stone surgery: state-of-the-art review

“… 36 - 38 These developments have contributed to the marked rise in the number of paediatric URS series which have been published, as well as the steady improvement in SFRs, which have been reported over recent years. 7 , 12 , 39 , 40 These advancements have also supported the use of URS for difficult scenarios such as lower pole stones and cystinuria. 41 , 42 …”

“…SFRs, which have been reported over recent years. 7,12,39,40 These advancements have also supported the use of URS for difficult scenarios such as lower pole stones and cystinuria. 41,42 Energy sources for lithotripsy.…”