Ee Jean Lim1, Olivier Traxer2, Yesica Quiroz Madarriaga3, Daniele Castellani4, Khi Yung Fong5, Vinson Wai-Shun Chan6, Anna Bujons Tur3, Amelia Pietropaolo7, Deepak Ragoori8, Anil Shrestha9, Chandra Mohan Vaddi10, Tanuj Paul Bhatia11, Mriganka Mani7, Patrick Juliebø-Jones7, Stephen Griffin7, Esther García Rojo12, Mariela Corrales2, Cagri Akin Sekerci13, Yiloren Tanidir13, Jeremy Yuen-Chun Teoh14, Vineet Gauhar15, Bhaskar Kumar Somani7. 1. Department of Urology, Singapore General Hospital, Singapore, Singapore. eejeanlim@gmail.com. 2. Department of Urology Hôpital Tenon, Sorbonne University, Paris, France. 3. Urology Department, Autonomous University of Barcelona, Fundació Puigvert, Barcelona, Spain. 4. Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy. 5. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 6. School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK. 7. University Hospital Southampton NHS Foundation Trust, Southampton, UK. 8. Department of Urology, Asian Institute of Nephrology and Urology, Banjara Hills, Hyderabad, Telangana, India. 9. Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kanti Path, Kathmandu, Nepal. 10. Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India. 11. Department of Urology, Sarvodaya Hospital Sarvodaya, Guwahati, Assam, India. 12. Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain. 13. Department of Urology, Marmara University School of Medicine, Istanbul, Turkey. 14. Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China. 15. Department of Urology, Ng Teng Fong Hospital, Singapore, Singapore.
Abstract
PURPOSE: To analyse and report the practice, outcomes and lessons learnt from a global series of retrograde intrarenal surgery (RIRS) in a paediatric multicentre series. METHODS: A retrospective review of anonymized pooled data gathered globally from 8 centres in paediatric patients (≤ 18 years of age) who had renal stones and underwent RIRS from 2015 to 2020 was performed. Patient demographics, perioperative parameters, stone characteristics, complications and stone-free rate (SFR; defined as endoscopically stone free and/or residual fragments < 2 mm on follow up imaging) were analysed. The cohort was stratified into 3 groups by age: < 5 years (Group A), 5-10 years (Group B) and > 10 years (Group C). Overall, post-operative complication rate was 13.7%. Chi-square comparisons were used for categorical variables; analysis of variance (ANOVA) or Kruskal-Wallis tests were used for continuous variables. RESULTS: 314 patients were analysed. The mean age was 9.54 ± 4.76 years. Groups A, B and C had 67 (21.3%), 83 (26.4%) and 164 (52.2%) patients, respectively. Mean stone size was 10.7 ± 4.62 mm. Pre-stenting was performed in 155 (49.4%) of patients, ureteral access sheaths (UAS) was used in 54.5% of patients with majority (71%) utilizing holmium laser for stone fragmentation. All complications were minor (Clavien-Dindo grade 1 and 2). SFR was 75.5%. CONCLUSIONS: RIRS is acceptable as a first-line intervention in the paediatric population with reasonable efficacy and low morbidity. Complications are slightly higher in patients < 5 years of age, which should be taken into account while counselling patients.
PURPOSE: To analyse and report the practice, outcomes and lessons learnt from a global series of retrograde intrarenal surgery (RIRS) in a paediatric multicentre series. METHODS: A retrospective review of anonymized pooled data gathered globally from 8 centres in paediatric patients (≤ 18 years of age) who had renal stones and underwent RIRS from 2015 to 2020 was performed. Patient demographics, perioperative parameters, stone characteristics, complications and stone-free rate (SFR; defined as endoscopically stone free and/or residual fragments < 2 mm on follow up imaging) were analysed. The cohort was stratified into 3 groups by age: < 5 years (Group A), 5-10 years (Group B) and > 10 years (Group C). Overall, post-operative complication rate was 13.7%. Chi-square comparisons were used for categorical variables; analysis of variance (ANOVA) or Kruskal-Wallis tests were used for continuous variables. RESULTS: 314 patients were analysed. The mean age was 9.54 ± 4.76 years. Groups A, B and C had 67 (21.3%), 83 (26.4%) and 164 (52.2%) patients, respectively. Mean stone size was 10.7 ± 4.62 mm. Pre-stenting was performed in 155 (49.4%) of patients, ureteral access sheaths (UAS) was used in 54.5% of patients with majority (71%) utilizing holmium laser for stone fragmentation. All complications were minor (Clavien-Dindo grade 1 and 2). SFR was 75.5%. CONCLUSIONS: RIRS is acceptable as a first-line intervention in the paediatric population with reasonable efficacy and low morbidity. Complications are slightly higher in patients < 5 years of age, which should be taken into account while counselling patients.
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