The aim of this study is to evaluate the outcomes of retrograde intra renal surgery (RIRS) in the setting of large or multiple stones in children (<18 years).
Retrospective analysis was performed of paediatric RIRS cases at nine centres worldwide over a 6-year period. Patients were divided into two groups: Group 1 had a single stone <15 mm. Group 2 had either multiple stones, maximum stone diameter of >15 mm, or both. Outcomes included stone free rate (SFR) and complications within 30 days.
In total, 344 patients were included with 197 and 147 in Groups 1 and 2, respectively. Ureteric access sheaths were more frequently used in Group 2 (39.5% vs. 56.8%, p = 0.021). The operation time was significantly longer in Group 2 (p < 0.001). SFR after a single procedure was 84.7% in Group 1 and 63.7% in Group 2. Overall complication rates in Groups 1 and 2 were 7.6% and 33.3%, respectively. The most frequently reported complication in both groups was post-operative fever (4.4% vs. 14%, p = 0.004). The rate of Clavien I/II complications in groups 1 and 2 was 6% and 25.1%, respectively (p < 0.05). The rate of Clavien ≥ III complications in groups 1 and 2 was 1.6% and 8.1%, respectively (p < 0.05). On multivariate analysis, total operation time, stone size and multiplicity were significant predictors of residual fragments.
RIRS can be performed in paediatric cases with large and multiple stone burdens, but the complication rate is significantly higher when compared to smaller stones.
BJUI compass. 2024 Mar 31*** epublish ***
Patrick Juliebø-Jones, Vineet Gauhar, Ee Jean Lim, Olivier Traxer, Yesica Quiroz Madarriaga, Daniele Castellani, Khi Yung Fong, Anna Bujons, Deepak Ragoori, Anil Shrestha, Chandra Mohan Vaddi, Tanuj Paul Bhatia, Cagri Akin Sekerci, Yiloren Tanidir, Jeremy Yuen-Chun Teoh, Bhaskar Kumar Somani
Department of Clinical Medicine University of Bergen Bergen Norway., Department of Urology Ng Teng Fong Hospital Singapore Singapore., Department of Urology Singapore General Hospital Singapore Singapore., Department of Urology Hôpital Tenon Sorbonne University Paris France., Urology Department Autonomous University of Barcelona, Fundació Puigvert Barcelona Spain., Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona Università Politecnica Delle Marche Ancona Italy., Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore., Department of Urology Asian Institute of Nephrology and Urology, Banjara Hills Hyderabad India., Department of Urology, National Academy of Medical Sciences Bir Hospital Kathmandu Nepal., Department of Urology Preeti Urology and Kidney Hospital Hyderabad India., Department of Urology Sarvodaya Hospital Sarvodaya Guwahati India., Department of Urology Marmara University School of Medicine Istanbul Turkey., Department of Surgery, S.H. Ho Urology Centre The Chinese University of Hong Kong Sha Tin Hong Kong, China., Department of Urology University Hospital Southampton Southampton UK.