Time to Reach Stone-free Status in Children Undergoing Retrograde Intrarenal Surgery
Urology Journal,
Vol. 22 No. 01 (2025),
12 January 2025
,
Page 25-30
https://doi.org/10.22037/uj.v21i.8270
Abstract
Purpose: Retrograde intrarenal surgery has become increasingly popular for renal stone disease but has very different stone-free rates in children. There is insufficient data in the literature regarding how long it takes to reach a stone-free status in children after retrograde intrarenal surgery. We aimed to evaluate the time to reach stone-free status and stone-free rates (SFR) in children who underwent retrograde intrarenal surgery.
Materials and Methods: This retrospective study included children who had undergone retrograde intrarenal surgery. Ultrasonography was performed three months after the procedures for 18 months to evaluate stone clearance. We analyzed the stone-free rate and time to reach stone-free status.
Results: One hundred and five patients (mean age 6.66 + 5.27 years) were evaluated. Fifteen patients had staghorn stones, 31 had multiple stones, and 44 had single stones. The median follow-up period was 29 months (9-44 months) Of the 90 patients who underwent RIRS as the first treatment option, 38 (42.2%) achieved stone-free status with a single procedure, while 30 (33.3%) required repeat RIRS and other procedures.The stone-free rate was achieved in 75.5% of the patients in a mean of 12.25+40.19 months, In the group with staghorn stones, stone-free status was achieved in 4-36 months with a mean of 16.85+12.03 months, in patients with multiple stones in 2-41 months with a mean of 12.72+10.03 months, and in patients with single stones in 1-36 months with a mean of 10.23+9.10 months. Although the staghorn group achieved stone-free time for longer than the other two groups, there was no significant relationship between the three groups (P = .131) and achieved stone-free time.
Conclusion: A stone-free status can be achieved in children 12 months after retrograde intrarenal surgery. Since stone-free status is achieved over a long period, patient follow-ups should be planned accordingly, and there should be no rush to perform additional interventions in asymptomatic cases with residual stones.
- Pediatric renal stone, Renal calculi, Retrograde intrarenal surgery, Stone-free rate
How to Cite
References
Clayton DB, Pope JC. The increasing pediatric stone disease problem. Ther Adv Urol. 2011;3(1):3-12.
Copelovitch L. Urolithiasis in children: medical approach. Pediatr Clin North Am. 2012;59(4):881-96.
Karagöz MA, Erihan IB, Doluoğlu ÖG, et al. Efficacy and safety of fURS in stones larger than 20 mm: Is it still the threshold? Cent European J Urol. 2020;73(1):49-54.
Ekici M, Ozgur BC, Senturk AB, et al. Efficacy and reliability of retrograde intrarenal surgery in treatment of pediatric kidney stones. Cureus. 2018;10(12):e3719-4.
Kahraman O, Dogan HS, Asci A, Asi T, Haberal HB, Tekgul S. Factors associated with the stone-free status after retrograde intrarenal surgery in children. Int J Clin Pract. 2021;75(10):e14667-3.
Thangavelu M, Sawant A, Sayed AA, et al. 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;29;94(2):190-194.
Ripollés T, Agramunt M, Errando J, Martínez MJ, Coronel B, Morales M. Suspected ureteral colic: plain film and sonography vs unenhanced helical CT. A prospective study in 66 patients. Eur Radiol. 2004 Jan;14(1):129-36.
Alsaywid BS, Mesawa AA, Mohammedkhalil AK, Almarghoub M, Barnawi Z, Abuznadah WT. Antibiotic prophylaxis in children with ureteric stents: Bliss or misery? Urol Ann. 2019 Oct-Dec;11(4):421-425.
Paick SH, Park HK, Oh SJ, Kim HH. Characteristics of bacterial colonization and urinary tract infection after indwelling of double-J ureteral stent. Urology. 2003 Aug;62(2):214-7.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–13
Ziaeefar P, Basiri A, Zangiabadian M, et al. Medical Expulsive Therapy for Pediatric Ureteral Stones: A Meta-Analysis of Randomized Clinical Trials. J Clin Med. 2023 Feb 10;12(4):1410-5.
Van Dervoort K, Wiesen J, Frank R, et al: Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome. J Urol. 2007;177(6):2300- 2305.
Ritchey M, Patterson DE, Kelalis PP, Segura JW: A case of pediatric ureteroscopic lasertripsy. J Urol. 1988;139(6):1272-1274.
Dawaba MS, Shokeir AA, Hafez A, et al. Percutaneous nephrolithotomy in children: early and late anatomical and functional results. J Urol. 2004;172(3):1078-1081.
Dogan HS, Tekgul S. Minimally invasive surgical approaches to kidney stones in children. Curr Urol Rep. 2012;13:298-306.
Gabrigna Berto F, Wang P, McClure JA et al. A population-based retrospective cohort study of surgical trends and outcomes of pediatric urolithiasis in Ontario, Canada (2002- 2019). J Pediatr Urol. 2023;19(6):784-791.
Gofrit ON, Pode D, Meretyk S et al. Is the pediatric ureter as efficient as the adult ureter in transporting fragments following extracorporeal shock wave lithotripsy for renal calculi larger than 10 mm.? J Urol. 2001;166(5):1862-1864.
Azili MN, Ozcan F, Tiryaki T. Retrograde intrarenal surgery for the treatment of renal stones in children: factors influencing stone clearance and complications. J Pediatr Surg. 2014;49(7):1161-1165.
Abu Ghazaleh LA, Shunaigat AN, Budair Z. Retrograde intrarenal lithotripsy for small renal stones in prepubertal children. Saudi JKidney Dis Transpl. 2011;22(3):492-496.
Kim SS, Kolon TF, Canter D, White M, Casale P. Pediatric flexible ureteroscopic lithotripsy: the children's hospital of Philadelphia experience. J Urol. 2008;180(6):2616-2619.
Berrettini A, Boeri L, Montanari E, et al. Retrograde intrarenal surgery using ureteral access sheaths is a safe and effective treatment for renal stones in children weighing <20 kg. J Pediatr Urol. 2018;14(1):59.e1-59.e6.
Cannon GM, Smaldone MC, Wu HY, et al. Ureteroscopic management of lower-pole stones in a pediatric population. J Endourol. 2007;21(10):1179-1182.
Li J, Xiao J, Han T, Tian Y, Wang W, Du Y. Flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants. Exp Biol Med (Maywood). 2017;242(2):153-159.
Sarikaya S, Ebiloglu T, Selvi I, Faruk Bozkurt O, Senocak C. Retrograde intrarenal surgery or percutaneous nephrolithotomy: Which one is more effective for 1-2 cm renal stones in pediatric patients? Arch Esp Urol. 2019;72(1):54-60.
He Q, Xiao K, Chen Y, Liao B, Li H, Wang K. Which is the best treatment of pediatric upper urinary tract stones among extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery: a systematic review. BMC Urol. 2019 Oct 23;19(1):98-3.
Sharifi Aghdas F, Akhavizadegan H, Aryanpoor A, Inanloo H, Karbakhsh M. Fever after percutaneous nephrolithotomy: contributing factors. Surg Infect (Larchmt). 2006;7(4):367-371.
- Abstract Viewed: 508 times
- 8270/pdf Downloaded: 293 times