Small Ureteral Access Sheath in Treating Paediatric Urolithiasis: A Single Centre Experience

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.

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

“…In the whole cohort including 1417 cases of pediatric URS with UAS placement, we reported 26 intraoperative and 130 postoperative complications, accounting for 1.8% and 9.18% of the overall procedures, respectively. Nevertheless, the use of a UAS did not cause any significant short- or long-term complication, as reported by the majority of these groups [18] , [20] , [22] , [26] , [39] .…”

“…None of them justified the choice of UAS placement based on a stone size threshold, stone location, age, or clinical characteristics of patients (weight, height, and comorbidities). Three studies were explicitly focused on the use of UAS [20] , [22] , [26] . Most of the studies attempted the placement of UAS in all cases.…”

“…Stone size was usually defined as the largest linear diameter of a single stone or the sum of long axes in the case of multiple stones. Ferretti et al [21] specified stone length range and stone surface area; others [22] subclassified stone burden in <10, 10–20, and >20 mm. There was great heterogeneity among studies regarding diagnostic investigations, with most groups using ultrasound for kidney, ureter, and bladder or x-rays, and occasional low-dose non-contrast computed tomography.…”

“…One study [30] did not report UAS caliber. UAS length was specified only in nine out of 22 studies, with four groups using a 35 cm UAS [13] , [20] , [22] , [31] , two using either a 20 or a 28 cm UAS [21] , [32] , one using a 28 cm UAS only [19] , one using either a 20 or a 35 cm UAS [18] , and one using either a 28 or a 35 cm UAS [24] .…”

“…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] .…”