Retrograde intrarenal surgery using ureteral access sheaths is a safe and effective treatment for renal stones in children weighing &lt;20 kg

Berrettini, Alfredo; Boeri, Luca; Montanari, Emanuele; Mogiatti, Mirella; Acquati, P.; Lorenzis, E. De; Gallioli, Andrea; Marco, Erika Adalgisa De; Minoli, Dario Guido; Manzoni, Gianantonio

doi:10.1016/j.jpurol.2017.09.011

Cited by 27 publications

(17 citation statements)

References 27 publications

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“…Berettini et al reported a good experience in 13 pts weighing < 20 kg who underwent to RIRS with UAS; all patients presented 2 weeks before surgery. In 93.8% of cases, the UAS was inserted without complications and, at a mean follow up of 22 months, no long-term post-surgical complication was reported (15). Erkurt et al reported the positioning of UAS in only 61.5% of cases and an incidence of 2 ureteral wall injuries due to sheath but without related complications at long-term follow up; in this population UAS before RIRS was inserted in 94.1% of pre-stented children and only 50% of non-stented patients (9).…”

Section: Discussionmentioning

confidence: 92%

“…To share knowledge between paediatric and adult surgeon (twin-surgeon model) as a tutor at the beginning of the learning curve could be the answer for higher and quickly levels of performances (14). The difficulty in performing ureteroscopy in children younger than 3 or 5 years (due to the smaller ureteral diameter) is well known (15)(16). Our data show that 4 out 13 not pre-stented patients were up to five years old and no one experienced access failure to ureters.…”

Section: Discussionmentioning

confidence: 99%

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Rigid and flexible ureteroscopy (URS/RIRS) management of paediatric urolithiasis in a not endemic country

Ferretti¹,

Cuschera

Campobasso³

et al. 2021

Arch Ital Urol Androl

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Introduction: In the last years due to miniaturization of endoscopic instruments and percutaneous surgery, endourology has become very popular in paediatric urinary stone managment. We reported our single-centre experience in retrograde endoscopic procedures in children. Results and complications of URS/RIRS are discussed. Materials and methods: We retrospectively reviewed our experience in patients ≤ 16 years old affected by urinary stones who underwent URS/RIRS procedures performed by two surgeons with expertise in endourology. A total of 30 renal Units (RUs) underwent endoscopic procedures (URS, RIRS or both). Surgical complications according to the ClavienDindo’s classification and stone-free rate were evaluated at 3 months follow-up. Success of URS was defined as stone-free status after single procedure while RIRS success rate was considered as presence of residual stone fragments smaller than 4 mm at first procedure. Results: The mean age of our patients was 8 years, range 2- 16 years. A total of 30 renal units (RUs) underwent 40 endourological procedures (23 URS and 17 RIRS; 10 children underwent both procedures at the same time). 17/30 (56.6%) RUs were pre-stented before surgery. The stone-free status was achieved in 23/30 renal units treated, with a 76.6% success rate. The remaining 7 patients had residual stones greater than 4 mm and underwent further treatments. After a second surgery the stone-free rate turned out to be 93.3% (28/30 renal units). Conclusions: Rigid and flexible ureteroscopy (URS/RIRS) is a reliable technique for treatment of < 2 cm urinary stones in paediatric age group. It shows low rate of major complications and promising results in terms of stone-free rate.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Rigid and flexible ureteroscopy (URS/RIRS) management of paediatric urolithiasis in a not endemic country

Ferretti¹,

Cuschera

Campobasso³

et al. 2021

Arch Ital Urol Androl

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“…All patients were stented 2 weeks before surgery. [ 31 ]9.5/11.5 Fr size UAS was used in all cases. During the follow-up period which extended up to a year, ureteral strictures or any chronic complication implicating ureteral wall injury was not observed.…”

Section: Resultsmentioning

confidence: 99%

Does ureteral access sheath have an impact on ureteral injury?

et al. 2022

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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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“…In literature use of passive dilatation ranges between 38% and 100%. 16,17,20 Ureteral access sheath provides continuous drainage of collecting system thus providing low pressure in a closed system and allowing repeatedly pass the ureteroscope to the upper system which allows stone fragment extraction with basket catheters. However, its use in paediatric patients is quite limited, because of the delicate nature of the paediatric ureter.…”

Section: European Association Of Urology/european Society Formentioning

confidence: 99%

“…In literature, SFR is between 58% and 94.6%. 20,21,23,28,29 In a systematic review in 2014, mean SFR was 85.5% after initial ureteroscopy. 30 Age of patients, instruments that were used and follow-up imaging modalities are all heterogenous between studies which make it difficult to compare SFR.…”

Section: European Association Of Urology/european Society Formentioning

confidence: 99%

Factors associated with the stone‐free status after retrograde intrarenal surgery in children

et al. 2021

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In recent years, there has been a marked increase in paediatric stone disease because of the changes in dietary habits and a more sedentary lifestyle. 1 Paediatric urolithiasis has a recurrent nature because it is frequently associated with metabolic or anatomical disorders or infectious conditions. 2 The rising incidence of the disease with its recurrent nature emphasises the need for minimally invasive therapeutic options. Among the options, there are extracorporeal shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), semirigid ureterorenoscopy (URS) and flexible retrograde intrarenal surgery (RIRS). 3 With the availability of smaller size instruments, RIRS became an attractive option also for children. Within years, a significant experience has been accumulated. Several previous studies reported different factors affecting the stone-free rates (SFR). 4 Stone size,

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Retrograde intrarenal surgery using ureteral access sheaths is a safe and effective treatment for renal stones in children weighing <20 kg

Cited by 27 publications

References 27 publications

Rigid and flexible ureteroscopy (URS/RIRS) management of paediatric urolithiasis in a not endemic country

Rigid and flexible ureteroscopy (URS/RIRS) management of paediatric urolithiasis in a not endemic country

Does ureteral access sheath have an impact on ureteral injury?

Factors associated with the stone‐free status after retrograde intrarenal surgery in children

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