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Sen H, Baydilli N, Ozturk M, Golbasi A, Seckiner İ, Demirci D. Factors effecting the success of retrograde intrarenal surgery in pediatric patients with renal stones: The experience of two tertiary centres with 368 renal units. J Pediatr Urol 2024; 20:403.e1-403.e9. [PMID: 38267307 DOI: 10.1016/j.jpurol.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/14/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024]
Abstract
INTRODUCTION AND OBJECTIVES Currently, in the field of pediatric urology, the primary aim of surgical approaches for the treatment of renal stone disease is to provide a stoneless state through minimally invasive methods, and to prevent the damage that such stones may cause in the urinary system and stone recurrence. The aim of this study was to evaluate the efficacy and safety of RIRS and the factors affecting its success in the surgical treatment of renal stones in pediatric patients. METHODS Data from 357 pediatric and 368 renal units were collected retrospectively. The recorded parameters were age, gender, location and burden of the stone, and presence of postoperative residual stones. RESULTS The stone location was the upper pole in 28 (7.6 %) patients, the middle pole in 44 (12 %), the pelvis in 98 (26.6 %), the lower pole in 139 (37.8 %), and multiple locations in 59 (16 %) patients. A stoneless state was achieved in 277 (75.3 %) units, while 91 units (24.7 %) had residual stones at the end of the first month. In the multivariate analysis, the development of residual stones was found to be significantly associated with age (odds ratio [OR], 1.123; p = 0.012) and stone location (OR, 3.142; p = 0.018). DISCUSSION RIRS is an endourological procedure with a high success rate in the achievement of a stoneless state in both pediatric and adult age groups, with an 82-100 % success rate reported in various studies. A full stoneless state was achieved in 277 (75.3 %) units after the initial RIRS in the present study, and full stone clearance was achieved in 304 units after the second RIRS session, with a success rate of 82.6 %. A limitation of our study is that it was not performed by a single surgeon, and stone samples could not be taken from all patients for stone analysis. CONCLUSION RIRS has also been associated with a high success rate in the endoscopic treatment of renal stones and is an efficient and safe method with a minimal rate of complications, especially in the pediatric age group.
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Affiliation(s)
- Haluk Sen
- University of Gaziantep, School of Medicine, Department of Urology, Turkey.
| | - Numan Baydilli
- University of Erciyes, School of Medicine, Department of Urology, Turkey.
| | - Mehmet Ozturk
- University of Gaziantep, School of Medicine, Department of Urology, Turkey.
| | - Abdullah Golbasi
- University of Erciyes, School of Medicine, Department of Urology, Turkey.
| | - İlker Seckiner
- University of Gaziantep, School of Medicine, Department of Urology, Turkey.
| | - Deniz Demirci
- University of Erciyes, School of Medicine, Department of Urology, Turkey.
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Tanidir Y, Sekerci CA, Bujons A, Castellani D, Ferretti S, Gatti C, Campobasso D, Quiroz Y, Teoh JYC, Pietropaolo A, Ragoori D, Bhatia TP, Vaddi CM, Shrestha A, Lim EJ, Fong KY, Sinha MM, Griffin S, Sarica K, Somani BK, Traxer O, Gauhar V. The Utility and Safety of Ureteral Access Sheath During Retrograde Intrarenal Surgery in Children. Urology 2024; 187:71-77. [PMID: 38432431 DOI: 10.1016/j.urology.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/15/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To compare retrograde intrarenal surgery (RIRS) with and without ureteral access sheath (UAS) in different pediatric age groups. METHODS The data of RIRS for kidney stone in children were obtained from 9 institutions. Demographic characteristics of patients and stones, intraoperative and postoperative results were recorded. While analyzing the data, patients who underwent RIRS without UAS (group 1) (n = 195) and RIRS with UAS (group 2) (n = 194) were compared. RESULTS Group 1 was found to be young, thin, and short (P <.001, P = .021, P <.001), but there was no gender difference and similar symptoms were present except hematuria, which was predominant in group 2 (10.6% vs 17.3%, P <.001). Group 1 had smaller stone diameter (9.91 ± 4.46 vs 11.59 ± 4.85 mm, P = .001), shorter operation time (P = .040), less stenting (35.7% vs 72.7%, P = .003). Re-intervention rates and stone-free rates (SFR) were similar between groups (P = .5 and P = .374). However, group 1 had significantly high re-RIRS (P = .009). SFR had a positive correlation with smaller stone size and thulium fiber laser usage compared to holmium fiber laser (HFL) (P <.001 and P = .020), but multivariate analysis revealed only large stone size as a risk factor for residual fragments (P = .001). CONCLUSION RIRS can be performed safely in children with and without UAS. In children of smaller size or younger age (<5 years), limited use of UAS was observed. UAS may be of greater utility in stones larger than 1 cm, regardless of the age, and using smaller diameter UAS and ureteroscopes can decrease the complications.
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Affiliation(s)
- Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Cagri Akin Sekerci
- Division of Pediatric Urology, Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Anna Bujons
- Urology Department, Autonomous University of Barcelona, Fundació Puigvert, Barcelona, Spain.
| | - Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy.
| | - Stefania Ferretti
- Urology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Claudia Gatti
- Pediatric Surgery Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Davide Campobasso
- Urology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Yesica Quiroz
- Urology Department, Autonomous University of Barcelona, Fundació Puigvert, Barcelona, Spain.
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China.
| | - Amelia Pietropaolo
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology and Urology, Banjara Hills, Hyderabad, Telangana, India.
| | - Tanuj Paul Bhatia
- Department of Urology, Sarvodaya Healthcare, Faridabad, Haryana, India.
| | - Chandra Mohan Vaddi
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India.
| | - Anil Shrestha
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kanti Path, Kathmandu, Nepal.
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore.
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Mriganka Mani Sinha
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Stephen Griffin
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.
| | - Kemal Sarica
- Department of Urology, Biruni University, Istanbul, Turkey.
| | - Bhaskar Kumar Somani
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Olivier Traxer
- Department of Urology Hôpital Tenon, Sorbonne University, Paris, France.
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong Hospital, Singapore, Singapore.
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3
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García-Rojo E, Traxer O, Vallejo Arzayús DM, Castellani D, Ferretti S, Gatti C, Bujons Tur A, Quiroz Madarriaga Y, Teoh JYC, Ragoori DR, Bhatia TP, Chandra Mohan V, Shrestha A, Lim EJ, Sinha M, Griffin S, Pietropaolo A, Fong KY, Tanidir Y, Somani BK, Gauhar V. Comparison of Low-Power vs High-Power Holmium lasers in pediatric RIRS outcomes. J Endourol 2023; 37:509-515. [PMID: 36860192 DOI: 10.1089/end.2022.0778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVES to compare the outcomes of using low-power (up to 30W) vs high-power (up to 120W) holmium lasers in retrograde intrarenal surgery (RIRS) in children and to analyse if lasering techniques and the use of access sheath have any influence on the outcomes. METHODS We retrospectively reviewed data from 9 centres of children who underwent RIRS with holmium laser for the treatment of kidney stones between January 2015 and December 2020. Patients were divided into two groups: high-power and low-power holmium laser. Clinical, perioperative variables and complications were analysed. Outcomes were compared between groups using Student's T-test for continuous variables, and Chi-square and Fisher's exact test for categorical variables. A multivariable logistic regression analysis model was also performed. RESULTS 314 patients were included. A high-power and low-power holmium laser was used in 97 and 217 patients, respectively. Clinical and demographic variables were comparable between both groups, except for stone size where the low-power group treated larger stones (mean 11.11 mm vs 9.70 mm; p 0.018). In the high-power laser group, a reduction in surgical time was found (mean 64.29 min vs 75.27 min; p 0.018) with a significantly higher stone-free rate (SFR) (mean 81.4% vs 59%; p <0.001). We found no statistical differences in complication rates. The multivariate logistic regression model showed lower SFR in the low-power holmium group, especially with larger (p = 0.011) and multiple stones (p < 0.001). CONCLUSION Our real-world pediatric multicenter study favours high-power holmium laser and establishes its safety and efficacy in children. .
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Affiliation(s)
- Esther García-Rojo
- Hospital Universitario HM Sanchinarro, 221921, Department of Urology, Calle Oña, 10, Madrid, 28050, Madrid, Spain, 28050;
| | - Olivier Traxer
- Sorbonne Universite, 27063, GRC#20 Lithiase Urinaire, Hôpital Tenon, Paris, Île-de-France, France;
| | | | - Daniele Castellani
- AOU Ospedali Riuniti di Ancona, 18494, via conca 71, Ancona, Italy, 60126;
| | | | - Claudia Gatti
- University Hospital of Parma, 18630, Pediatric Surgery, Parma, Emilia-Romagna, Italy;
| | - Anna Bujons Tur
- Fundacio Puigvert, 16444, Pediatric Urology, Barcelona, Catalunya, Spain;
| | | | - Jeremy Y C Teoh
- Prince of Wales Hospital, Surgery, 30-32 Ngan Shing Street, Shatin, New Territories., Hong Kong, Hong Kong;
| | - Deepak Reddy Ragoori
- Asian Institute of Nephrology and Urology, 519389, Urology, 6-3-562/A, behind MORE megamart, Errum Manzil, Hyderabad, Telangana, India, 500082;
| | - Tanuj Paul Bhatia
- Sarvodaya Hospital, 76257, Urology, Sector 8, Faridabad, Faridabad, Haryana, India, 121006.,Sarvodaya Hospital and research centre, Sector 8, Faridabad, Faridabad, India;
| | - Vaddi Chandra Mohan
- preeti urology and kidney hospital, Urology, MIG-1,307, Raod No.4 , KPHB Colony, Kukatpally, Hyderabad, hyderabad, Telangana, India, 500072;
| | | | - Ee Jean Lim
- Singapore General Hospital, Department of Urology, Academia Level 5, 20 College Rd, Singapore 169856, Singapore, Singapore, 169856;
| | - Mrigyanka Sinha
- University Hospitals Southampton NHS Trust, Urology, Southampton, United Kingdom of Great Britain and Northern Ireland;
| | - Stephen Griffin
- University Hospitals Southampton NHS Trust, Paediatric Urology, Southampton, United Kingdom of Great Britain and Northern Ireland;
| | - Amelia Pietropaolo
- University Hospitals Southampton NHS Trust, Urology, Southampton, United Kingdom of Great Britain and Northern Ireland;
| | - Khi Yung Fong
- National University of Singapore, 37580, Singapore, Singapore;
| | - Yiloren Tanidir
- Marmara University School of Medicine, Urology, Marmara Universitesi Pendik EAH, Fevzi Cakmak Mah. Mimar Sinan Cad., No:41 Uroloji AD. Kat:4, Ust kaynarca / Pendik, Istanbul, Turkey, 34899;
| | - Bhaskar K Somani
- University Hospitals Southampton NHS Trust, Urology, Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland, SO16 6YD.,United Kingdom of Great Britain and Northern Ireland;
| | - Vineet Gauhar
- Ng Teng Fong General Hospital, 242949, Urology, Singapore, Singapore;
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Quiroz Y, Somani BK, Tanidir Y, Tekgul S, Silay S, Castellani D, Lim EJ, Fong KY, Garcia Rojo E, Corrales M, Hameed BMZ, Llorens E, Teoh JYC, Dogan HS, Traxer O, Bujons Tur A, Gauhar V. Retrograde Intrarenal Surgery in Children: Evolution, Current Status, and Future Trends. J Endourol 2022; 36:1511-1521. [PMID: 35972727 DOI: 10.1089/end.2022.0160] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Introduction: Incidence of urolithiasis in children has increased in recent years and with technological advancements and miniaturization of surgical instruments, pediatric urologists have acquired an impressive arsenal for their treatment. Retrograde intrarenal surgery (RIRS) has gained widespread popularity as it is a natural extension of semirigid ureteroscopy and can be done through natural orifice minimizing the morbidity of percutaneous access. The aim of this narrative review is to describe how RIRS has evolved over the decades in children and if the age-related anatomical difference impacts reported outcomes especially stone-free rate (SFR) and complications. Materials and Methods: An electronic literature search from inception to October 15, 2021 was performed using Medical Subject Heading terms in several combinations on PubMed, EMBASE, and Web of Science without language restrictions. A total of 2022 articles were founded and 165 articles were full-text screening. Finally, 2 pediatric urologists included 51 articles that summarize the available literature regarding the development and use of RIRS in children. Results: RIRS as of today is well established as a superior modality for all stones in all locations compared with extracorporeal shockwave lithotripsy both in children and adults. The passive dilation has decreased the need of active ureteral dilation, but the need to perform prestenting is not defined yet. Regarding the use of the ureteral access sheath, the literature tends to lean toward its placement in most cases, but we do not know its long-term effects over the growth of children. Finally, the SFR has increased as the experience of pediatric urologists increases, as well as the number of complications has decreased. Conclusion: RIRS in pediatrics has crossed many milestones, yet many areas need further research and larger data are required to make RIRS the procedure of choice for renal stone management in children across all age groups.
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Affiliation(s)
- Yesica Quiroz
- Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Medical School, Hacettepe University, Ankara, Turkey
| | - Selcuk Silay
- Department of Urology, Istanbul Biruni University, Istanbul Medeniyet University, Istanbul Memorial Hospital, Istanbul, Turkey
| | - Daniele Castellani
- Department of Urology, Division of Urology, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Khi Yung Fong
- Department of Urology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Esther Garcia Rojo
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Mariela Corrales
- Department of Urology, Hôpital Tenon, Sorbonne University, Paris, France
| | - B M Zeeshan Hameed
- Department of Urology, Father Muller Medical College Mangalore, Karnataka, India
| | - Erika Llorens
- Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Hasan Serkan Dogan
- Division of Pediatric Urology, Department of Urology, Medical School, Hacettepe University, Ankara, Turkey
| | - Olivier Traxer
- Department of Urology, Hôpital Tenon, Sorbonne University, Paris, France
| | - Anna Bujons Tur
- Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, NUHS, Singapore, Singapore
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5
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Ripa F, Tokas T, Griffin S, Ferretti S, Bujons Tur A, Somani BK. Role of Pediatric Ureteral Access Sheath and Outcomes Related to Flexible Ureteroscopy and Laser Stone Fragmentation: A Systematic Review of Literature. EUR UROL SUPPL 2022; 45:90-98. [PMID: 36267473 PMCID: PMC9576810 DOI: 10.1016/j.euros.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 11/17/2022] Open
Abstract
Context Flexible ureteroscopy and laser lithotripsy (FURSL) represent a good treatment option for pediatric urolithiasis. Scarce evidence is available about the safety and efficacy of the concomitant use of a ureteral access sheath (UAS) in the setting of pediatric ureteroscopy (URS). Objective To acquire all the available evidence on UAS usage in pediatric FURSL, focusing on intra- and postoperative complications and stone-free rates (SFRs). Evidence acquisition We performed a systematic literature research using PubMed/MEDLINE, Embase, and Scopus databases. The inclusion criteria were cohorts of pediatric patients <18 yr old, submitted to URS for FURSL, reporting on more than ten cases of UAS placement. The primary outcomes were prestenting rates, operating time, ureteric stent placement rates after surgery, rates and grades of complications, ureteral injuries, and overall SFR. A total of 22 articles were selected. Evidence synthesis In total, 26 intraoperative and 130 postoperative complications following URS with UAS placement were reported (1.8% and 9.18% of the overall procedures, respectively). According to the Clavien-Dindo classification, 32 were classified as Clavien I, 29 as Clavien II, 43 as Clavien I or II, six as Clavien III, and one as Clavien IV. Twenty-one cases of ureteral injuries (1.59%) were noted in the whole cohort; most of them were ureteral perforation or extravasation, and were treated with a temporary indwelling ureteric stent. The overall SFR after a single URS procedure was 76.92%; after at least a second procedure, it was 84.9%. Conclusions FURSL is a safe and effective treatment option for pediatric urolithiasis. UAS use was associated with a low rate of ureteric injuries, mostly treated and resolved with a temporary indwelling ureteric stent. Patient summary We performed a systematic literature research on the utilization of a UAS during ureteroscopy for stone treatment in pediatric patients. We assessed the outcomes related to the rates of intra- and postoperative complications and the rates of efficacy of the procedure in the clearance of stones. The evidence shows a low rate and grade of complications associated with UAS placement and good stone-free outcomes. A ureteric injury may occur in 1.6% of cases, but it is usually managed and resolved with a temporary indwelling ureteric stent.
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Affiliation(s)
- Francesco Ripa
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall in Tirol, Hall in Tirol, Austria,Training and Research in Urological Surgery and Technology (T.R.U.S.T.) Group
| | - Stephen Griffin
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Bhaskar K. Somani
- University Hospital Southampton NHS Foundation Trust, Southampton, UK,Corresponding author. University Hospital Southampton NHS Trust, Southampton, UK. Tel. +44 02381206873.
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Abstract
PURPOSE OF REVIEW The aim of this study was to discuss current trends and recent developments in the surgical management of paediatric urolithiasis. RECENT FINDINGS Medical 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). SUMMARY Management of paediatric stone disease has developed significantly in the past decade. However, the evidence in the literature remains disproportional to these advances. Well designed multicentric studies are still needed to compare effectiveness and safety of these procedures.
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7
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Thangavelu M, Sawant A, Sayed AA, Pawar P, Hamid M, Patil S, Bhise V, Mathews J, Shewale R, Gadodia M. Retrograde Intrarenal Surgery (RIRS) for upper urinary tract stones in children below 12 years of age: A single centre experience. Arch Ital Urol Androl 2022; 94:190-194. [PMID: 35775346 DOI: 10.4081/aiua.2022.2.190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
| | - Ajit Sawant
- Department of Urology, LTMC and General Hospital, Sion, Mumbai.
| | - Ali Abbas Sayed
- Department of Urology, LTMC and General Hospital, Sion, Mumbai.
| | - Prakash Pawar
- Department of Urology, LTMC and General Hospital, Sion, Mumbai.
| | - Mohamed Hamid
- Department of Urology, LTMC and General Hospital, Sion, Mumbai.
| | - Sunil Patil
- Department of Urology, LTMC and General Hospital, Sion, Mumbai.
| | - Vikas Bhise
- Department of Urology, LTMC and General Hospital, Sion, Mumbai.
| | - Jeni Mathews
- Department of Urology, LTMC and General Hospital, Sion, Mumbai.
| | - Raunak Shewale
- Department of Urology, LTMC and General Hospital, Sion, Mumbai.
| | - Mohan Gadodia
- Department of Urology, LTMC and General Hospital, Sion, Mumbai.
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8
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Al-Aown A, Asutay M, Lattarulo M, Liourdi D, Pagonis K, Nedal N, Pietropaolo A, Emiliani E, Liatsikos E, Kallidonis P. Does ureteral access sheath have an impact on ureteral injury? Urol Ann 2022; 14:1-7. [PMID: 35197695 PMCID: PMC8815358 DOI: 10.4103/ua.ua_163_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: To present a well-organized review about ureteral access sheath impact on ureteral injury. Materials and Methods: Systemic search on literature was done. Total of 3766 studies observed by two urologists and results were unified. A Prisma diagram was used for eliminating irrelevant studies and at the end of elimination process 28 studies were found eligible for this review. Results: Not only clinical studies but also comparative experimental animal studies show that there is no significant data to claim that ureteral access sheath insertion causes more ureteral injury. Pre-stented patients were found to be at lower risk for ureteral injury. Risk of progression to ureteral injury seems to be low even if ureteral injury occurs with insertion of ureteral access sheath. Conclusion: Summary of studies’ results indicate that use of ureteral access sheath doesn’t increase ureteral injury. This review may help understanding safety profile of ureteral access sheath on evidence-based level. There is not enough data to make a statement that ureteral access sheath prevents ureteral injury.
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9
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Mosquera L, Pietropaolo A, Brewin A, Madarriaga YQ, de Knecht EL, Jones P, Bujons A, Griffin S, Somani BK. 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. [PMID: 33891927 DOI: 10.1016/j.urology.2021.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/03/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To look at the safety and outcomes of using ureteral access sheath (UAS) for pediatric renal stones. The use of UAS is variable in urological practice with very little clinical work on their use in pediatric kidney stone disease. PATIENTS AND METHODS Data was retrospectively collected from 2 large European tertiary endourology centers for all pediatric patients (≤16 years) with renal stones who underwent flexible ureteroscopy and lasertripsy (FURSL) via UAS. Data was collected on patient details, stone demographics and clinical outcomes of the FURSL procedure. RESULTS Forty-eight patients with a mean age of 10.7 years were treated with FURSL for a mean single and cumulative stone size of 10.4 mm and 15 mm respectively, with two-third having multiple stones and stones in the lower pole. The initial and final stone free rate (SFR) was 66.7% and 100% respectively with 1.3 procedures/patient. One patient each had intra-operative grade 1 ureteric injury and post-operative UTI, with no other injuries or complications noted. Over a mean follow-up of 17 months, no other complications were noted. CONCLUSION Ureteral access sheath is safe for treatment of pediatric renal stones with excellent outcomes and are especially useful for larger or multiple stones. While there does not seem to be any medium-term sequalae, to avoid risk of ureteral injury, we would suggest using the smallest size sheath possible. We would argue these procedures are best done in specialist high-volume endourology units for optimal results.
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Affiliation(s)
- L Mosquera
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - A Pietropaolo
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - A Brewin
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | | | | | - P Jones
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - A Bujons
- Urology Department, Fundació Puigvert, Barcelona, Spain
| | - S Griffin
- Southampton Children's Hospital NHS Trust, Southampton, United Kingdom
| | - B K Somani
- University Hospital Southampton NHS Trust, Southampton, United Kingdom.
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Zhao FZ, Li J, Tang L, Li CM, Yu Z, Wang WY, Ning C, Tian Y. External Validation of Two Predictive Models for Postoperative Fever After Retrograde Intrarenal Surgery in Pediatric Patients. J Endourol 2021; 35:1135-1139. [PMID: 33528290 DOI: 10.1089/end.2020.0905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study is to validate the efficacy and reliability of two predictive models for postoperative fever after retrograde intrarenal surgery (RIRS) in pediatric patients Materials and Methods: A total of 124 children who were treated with RIRS between August 2014 and August 2020 in our center were included. All the predictors were obtained by preoperative routine examinations. Receiver operative curve (ROC) and area under curve (AUC) were showed to compare the predictive power of the two models. Results: One hundred twenty-four children included of 94 boys and 30 girls, with median ages of 2.1 (1.3, 7.0) years and median body mass index of 17.3 (15.6, 20.6) kg/m2. The total points of the two nomograms were 81.0 (67.3, 90.3) and 45.5 (20.4, 94.0). Eventually, 21 children (16.9%) suffered from postoperative fever. With the exception of C-reactive protein values (25.0 mg/L vs 5.0 mg/L, p = 0.015), irrigation volumes (800 mL vs 500 mL, p = 0.01), and total points of the two predictive models (Nomogram 1: 88.0 vs 76.0, p < 0.001; Nomogram 2: 76.0 vs 39.0, p = 0.016), there was no statistical difference detected between the fever and nonfever groups. ROCs showed that Nomogram 1 presented with better predictive accuracy and efficacy with excellent AUC values of 0.805 in comparison with Nomogram 2 (0.805 vs 0.664, p = 0.025). Conclusion: We reported a sample of 124 children undergoing RIRS with a final stone-free rate of 87.1%. Twenty-one pediatric patients (16.9%) suffered from postoperative fever. Nomogram 1 presented with better predictive power for postoperative fever after RIRS in pediatric patients.
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Affiliation(s)
- Fang-Zhou Zhao
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Jun Li
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Lei Tang
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Chun-Ming Li
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Zhang Yu
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Wen-Ying Wang
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Chen Ning
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Ye Tian
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
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11
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Aljumaiah S, Allubly N, Alshammari A, Alkhamees M, Hamri SB. Small Ureteral Access Sheath in Treating Paediatric Urolithiasis: A Single Centre Experience. Res Rep Urol 2020; 12:663-668. [PMID: 33376709 PMCID: PMC7764550 DOI: 10.2147/rru.s277855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/30/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction Urolithiasis is not commonly encountered in the pediatric population. The adoption of ureteral access sheaths (UAS) facilitates the passage to the pediatric ureter and limits the harm and ureteral injury. However, the debate continues regarding whether or not to use UAS in children. Objective To assess the safety and outcomes of using UAS in the treatment of pediatric renal and ureteral stones. Study Design This was a prospective cohort study of 14 pediatric patients who underwent flexible ureteroscopy (fURS) with the use of UAS for symptomatic renal and ureteric stones. Results Of the fourteen enrolled patients, nine (64.3%) were males, and five (35.7%) were females with an average age of 9.5 years. Eleven (78.6%) of the patients were rendered stone-free. The average operative time was 55.7 min. None of the patients developed any complications. The stone-free rate was significantly higher with stone burdens of ≤10 mm (p ≤ 0.05). Conclusion The use of UAS in children facilitates the passage of a flexible ureteroscope without complications. The procedure is considered to be efficient and safe with minimal morbidity.
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Affiliation(s)
- Sahar Aljumaiah
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh 11426, Saudi Arabia
| | - Nasser Allubly
- Department of Urology, Department of Surgery, King Fahad Hufof Hospital, Al-Ahsa, Saudi Arabia
| | - Ahmad Alshammari
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh 11426, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 11426, Saudi Arabia
| | - Mohammad Alkhamees
- Department of Urology, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh 11426, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 11426, Saudi Arabia
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12
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Huang JS, Xie J, Huang XJ, Yuan Q, Jiang HT, Xiao KF. Flexible ureteroscopy and laser lithotripsy for renal stones 2 cm or greater: A single institutional experience. Medicine (Baltimore) 2020; 99:e22704. [PMID: 33120764 PMCID: PMC7581148 DOI: 10.1097/md.0000000000022704] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
With improvements in endoscopy and laser technology, flexible ureteroscopy (FURS) has been a viable treatment option for large renal stones. Here, we share our experience of the FURS treatment for renal stones 2 cm or greater.We evaluated 251 consecutive patients who underwent FURS and holmium laser lithotripsy for renal stones 2 cm or greater between January 2015 and April 2019. Stone size was defined as the longest axis on non-contrast computed tomography. Data were retrospectively collected from electronic medical records. Patient demographics, stone clearance rates and perioperative complications were evaluated.There were 165 male patients and 86 female patients with an average age of 46.9 years (range 22-80 years). Mean stone size was 2.7 cm and the average number of procedures was 1.4 (range 1-5). The stone-free rate at the end of the first, second and third procedure was 61.9%, 82.9%, and 89.5%, respectively. The final stone-free rate decreased as stone size grows, and it was only 58.3% for kidney stones larger than 4 cm after an average of 2.3 procedures. The lowest clearance rates were observed in lower calyx calculi (87.2%) and multiple calyx calculi (83.5%). The overall complication rate was 15.1%, and the most common complication was postoperative fever (9.6%). One patient required blood transfusion, owing to postoperative coagulation disorders induced by urosepsis.Single or staged FURS is a practical treatment option for the renal stones sized 2 to 4 cm with acceptable efficacy and safety. Stone clearance rate of FURS treatment is mainly affected by stone size and location.
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Lima A, Reeves T, Geraghty R, Pietropaolo A, Whitehurst L, Somani BK. Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period. World J Urol 2020; 38:1329-1333. [PMID: 31342247 PMCID: PMC7190582 DOI: 10.1007/s00345-019-02878-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/16/2019] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To compare the outcomes (stone free rate and complications) of renal stone treatment with and without the use of ureteral access sheath (UAS). The worldwide use of UAS has risen over the last decade; however, questions still remain on the safety and outcomes with its use. We wanted to look at the role of UAS for treatment of consecutive renal stones over a 7-year period. METHODS The outcomes of flexible ureteroscopy and stone treatment (FURS) for renal stones with and without the use of UAS was prospectively compared from March 2012 to July 2018. Patients were divided into two groups: group-1 where UAS was used for stone treatment and group-2 where a UAS was not used. Data were collected prospectively on consecutive patients for demographics, stone size, location and number, pre and post-operative stent usage, operative time duration, stone free rate (SFR), length of stay and complications. RESULTS During the study period, 338 patients underwent FURS for renal stones, of which a UAS was used for 203 (60%) patients. The mean age of patients was 56 years (range 2-89 years) with a male:female ratio of 204:134. The mean cumulative stone size and the mean number of stones was 16.5 ± 10.8 mm and 11.37 ± 8.08 mm (P < 0.001), and 2.17 ± 1.99 and 1.66 ± 1.50 (P = 0.009) for groups 1 and 2 respectively. The pre and post-operative stent insertion rates were similar in the two groups. The procedural time was longer in group-1 (54.8 ± 25.8 min) compared to group-2 (41.3 ± 22.2 min) (P < 0.001). The SFR for group-1 (88%) was slightly lower than group-2 (94%) although this was not statistically significant (P = 0.07). There were no intra-operative complications in either of the groups. Post-operative complications were seen in eight patients in group-1 (7 Clavien I/II and 1 Clavien IVa) and two patients in group-2 (Clavien I) (P = 0.19). CONCLUSION The use of UAS for renal stones is safe with no intra-operative complications noted in our series. Good stone-free rates were obtained for large and multiple renal stones with a small risk of minor complications post-operatively.
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Affiliation(s)
- Ashleigh Lima
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD UK
| | - Thomas Reeves
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD UK
| | - Robert Geraghty
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD UK
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD UK
| | - Lily Whitehurst
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD UK
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD UK
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Abstract
PURPOSE OF REVIEW The purpose of this review is to describe the options and recent developments in the urologic treatment of nephrolithiasis in children. The prevalence of nephrolithiasis in children has increased over time. The urologic treatment of nephrolithiasis ranges from observation to medical expulsive therapy with an alpha blocker for a stone in a ureter to a variety of procedures for stone removal. RECENT FINDINGS Observation for small, asymptomatic renal stones is a reasonable strategy in children. Medical expulsive therapy with an alpha blocker may have a beneficial effect for passage of ureteral stones in children. Extracorporeal shock wave lithotripsy (ESWL) remains an important treatment for nephrolithiasis in children. Advances in ureteroscopy with clearer digital imaging and single use ureteroscopes have made ureteroscopy more attractive. Percutaneous nephrolithotomy is a more invasive treatment modality but remains a good choice for children with large-stone burdens and instruments are getting smaller. Open or laparoscopic stone surgery should be reserved for unique cases. SUMMARY Nephrolithiasis is increasing in children with differing urologic management options depending on the clinical scenario. A shared decision-making process with discussion of risks and benefits should be used to help patients and families choose a treatment option.
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Somani BK, Ploumidis A, Pappas A, Doizi S, Babawale O, Dragos L, Sener E, Talso M, Tefik T, Kronenberg P, Emiliani E, Villa L, Kamphuis G, Proietti S, Traxer O. Pictorial review of tips and tricks for ureteroscopy and stone treatment: an essential guide for urologists from PETRA research consortium. Transl Androl Urol 2019; 8:S371-S380. [PMID: 31656743 DOI: 10.21037/tau.2019.06.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
With an increase in the number of ureteroscopy (URS) procedures, URS is now performed more widely and is becoming a standard procedure for all urologists. There is also a rise in the complexity of these procedures and URS is now offered for treatment of stones as well as for diagnosis and treatment of urothelial tumours. We wanted to provide a 'pictorial review' of the 'tips and tricks' of URS, as the finer and technical details are often easier to understand and remember with images rather than through textual explanations.
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Affiliation(s)
| | | | | | - Steeve Doizi
- Sorbonne Université, GRC n°20 LITHIASE RENALE, AP-HP, Hôpital Tenon, 75020 Paris, France
| | | | - Laurian Dragos
- University of Medicine and Pharmacy, Victor Babes, Timisoara, Romania
| | - Emre Sener
- Urology Department, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Tzevat Tefik
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Esteban Emiliani
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Luca Villa
- Division of Experimental Oncology and Unit of Urology, Urological Research Institute, San Raffaele Hospital, Milan, Italy
| | - Guido Kamphuis
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Silvia Proietti
- IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy
| | - Olivier Traxer
- Sorbonne Université, GRC n°20 LITHIASE RENALE, AP-HP, Hôpital Tenon, 75020 Paris, France
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