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Demonstration of retrograde intra-renal surgery (RIRS) procedure steps in one of the cases of a child with a 2 cm renal stone. (A) insertion of ureteral access sheath (UAS). (B, C) insertion of the flexible ureteroscope accessing the lower pole.
Source publication
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...
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Purpose
The robotic system CoFlex for kidney stone removal via flexible ureteroscopy (fURS) by a single surgeon (solo surgery, abbreviated SSU) is introduced. It combines a versatile robotic arm and a commercially available ureteroscope to enable gravity compensation and safety functions like virtual walls. The haptic feedback from the operation si...
In ureteroscopy, a common method for kidney stone removal, a ureteroscope is inserted into the patient’s kidney, through which working tools such as a laser are inserted. During the procedure, the renal space proximal to the scope tip is irrigated with fluid in order to clear stone particles and debris. However, even with continual fluid flow into...
Introduction:
Saline solution is the standard irrigant used during ureteroscopy. However, there is an opinion that water has better visual clarity. We aimed to compare the visual clarities of saline, water, and 5% mannitol as an irrigant during ureteroscopy.
Material and methods:
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Citations
... 3 Nevertheless, it is worth highlighting that the most significant drawback of UAS lies in the potential for severe ureteral wall injury during insertion, including ureteral perforation or even avulsion, especially when inserted into a constricted ureter or inadvertently during the use of multiple baskets for fragment retrieval. 4 The efficacy and safety of using UAS in children have been explored in few studies, albeit small with relatively small cohorts [5][6][7][8][9][10][11] These studies collectively demonstrate that UAS usage in pediatric cases to be both safe and effective resulting in favorable outcomes, such as high stone-free rate (SFR) and minimal complications. However, it is noteworthy that, in contrast to the extensive body of research on adults, the evaluation of UAS's specific impact on surgical outcomes and complications in children with kidney stones has been limited to just 1 study. ...
... Although the use of UAS has proven safe and can lead to a reduction of intrarenal pressure and temperature in children, there still is the concern of ureteric injury [19,20,21]. The use of smaller UAS leads to a lower rate of ureteric injuries [19,22] and might lead to less need of post operative stent placement. While this study is the first study to report outcomes of endoscopic stone treatment pediatric patients with a 7.5 Fr single use flexible ureteroscope and was carried out in high volume endourology centers with data retrieved for consecutive patients, it was ...
Introduction
Although pediatric urolithiasis remains relatively uncommon, its global prevalence is on the rise. Technological advances have led to miniaturization of instruments especially in the form of single use scopes. As the evidence on the use of small single use ureteroscopes in children is scarce, we have conducted a pilot two-center study to analyze the outcomes of pediatric patients treated with the Pusen 7.5 Fr single use scopes at our institutions.
Material and methods
This study included consecutive pediatric patients with urinary stones treated with the small Pusen 7.5 Fr single use ureteroscope. The study was conducted at two large European tertiary endourology centers that specialize in pediatric kidney stone management. Patient data and outcomes were prospectively collected, and analysis was performed regarding patient demographics, stone parameters, as well as stone free rate (SFR), operating time, and complications.
Results
In this pilot study, 26 patients were included with a median age of 12 years (7.0–16.0) and a male to female ratio of 14:12. The mean cumulative stone size was 15.15 mm (SD ±11.1) and multiple stones were present in 9 (34.6%) patients. Pre-operative stent, access sheath and post-operative stent usage was done in 12 (46.2%), 23 (88.5%) and 13 (50%) patients respectively. The median operative time was 47 minutes (IQR: 40.0–63.8). Following the initial procedure 24 (92.3%) patients were stone free, while no intra or postoperative complications were observed.
Conclusions
Our study demonstrates that the use of the small 7.5 single use ureteroscope is safe and efficient for the treatment of urinary stones in pediatric patients with high stone-free rates and no complications noted in our series. While this might become a standard of care in future, to confirm and validate our findings further studies with larger cohorts are warranted.
... If the ureter was tight or small, and UAS was difficult to be inserted, the flexible ureteroscope was introduced without UAS. 7,9 Pediatric Flex X2 Storz flexible ureteroscope 7.5 Fr was used. Inspection of the whole pelvicalyceal had been carried out to count and locate the stones. ...
... Inspection of the whole pelvicalyceal had been carried out to count and locate the stones. 7,9 Two hundred microns of Holmium laser fiber was used to dust or fragment the stones. A nitinol basket (1.9 microns) was employed to transfer the stones or stone fragments from the lower calyx to the upper calyx. ...
... In the end, a ureteric JJ stent was implanted for everyone and removed 2 to 4 weeks later. 8,9 Patients left the hospital on the same day or a day after surgery and followed up in the outpatient clinic. Perioperative and postoperatively possible complications were recorded and graded according to the Clavien-Dindo system. ...
Objectives. To assess the effectiveness and safety of flexible ureteroscopy in children treated at our center during the last 5 years. Methods. Retrospectively, we have studied 41 children that suffered 51 stone episodes, and FURS for renal calculi <2 cm. Preoperative, operative, and postoperative data were gathered. Results. The mean age of the 41 kids who experienced 51 stone episodes was 9.6 [2.8] years (4.2-16 years). The mean stone diameter was 12.8 [3.3] mm (6-20 mm). The mean operative time was 79.9 [19.9] minutes. The mean hospital stay was 27.6 [12.9] hours. The SFR after the first session was 64.7% and 80.4% after the second session. The overall complications had been recorded in 25 cases (49%) with low morbidity (Clavien grade I-III). Conclusions. Pediatric FURS is a minimally invasive option with a high SFR and a low percentage of high-grade complications in the management of pediatric renal stones.
... However, use of UAS in that particular study did not lead to any significant difference in the SFR. One measure to the reduced risk of injury associated with UAS is to use a smaller size, for example, 10/12 Fr. 53,55 Even though the larger UASs have been repeatedly associated with lower intrarenal pressure and temperature, 56,57 one should rather consider the ratio or the cross-sectional area between the ureteroscope and the UAS, which would take into consideration the space available for irrigation fluid outflow. 58,59 As a matter of fact, the use of a 7.5-F scope with a 10/12-F UAS would theoretically achieve a similar pressure and temperature reduction compared with a 10-F scope with a 12/14-F UAS because the available space between the scope and the inner wall of the UAS would be almost the same in both scenarios (3.8 mm 2 ) and it is this space that allows for irrigational outflow (Table 2). ...
While urolithiasis in children is rare, the global incidence is rising, and the volume of minimally invasive surgeries being performed reflects this. There have been many developments in the technology, which have supported the advancement of these interventions. However, innovation of this kind has also resulted in wide-ranging practice patterns and debate regarding how they should be best implemented. This is in addition to the extra challenges faced when treating stone disease in children where the patient population often has a higher number of comorbidities and for example, the need to avoid risk such as ionising exposure is higher. The overall result is a number of challenges and controversies surrounding many facets of paediatric stone surgery such as imaging choice, follow-up and different treatment options, for example, medical expulsive therapy, shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. This article provides an overview of the current status of paediatric stone surgery and discussion on the key topics of debate.
... 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]. ...
Context: Flexible ureteroscopy and laser lithotripsy (FURSL) represent a good treatment option for pediatric urolithiasis. Scarce evidence is available about the safety and efficacy of the concomitant use of a ureteral access sheath (UAS) in the setting of pediatric ureteroscopy (URS). Objective: To acquire all the available evidence on UAS usage in pediatric FURSL, focusing on intra- and postoperative complications and stone-free rates (SFRs). Evidence acquisition: We performed a systematic literature research using PubMed/MEDLINE, Embase, and Scopus databases. The inclusion criteria were cohorts of pediatric patients
Introduction:
Incidence of urolithiasis in children has increased in recent years and with technological advancements and miniaturization of surgical instrumental, pediatric urologists have acquired an impressive arsenal for their treatment. Retrograde intrarenal surgery (RIRS) has gained widespread popularity as it is a natural extension of semirigid ureteroscopy (URS) and can be done via natural orifice minimizing the morbidity of percutaneous access. The aim of this narrative review is to describe how RIRS has evolved over the decades in children and if the age related anatomical differences impacts reported outcomes especially stone free rate (SFR) and complications.
Materials and method:
An electronic literature search from inception to 15 October 2021 was performed using Medical Subject Heading (MeSH) terms in several combinations on PUBMED, EMBASE and Web of science without language restrictions. 2022 articles were founded and 165 papers were full-text screening. Finally, 2 pediatric urologists included 51 articles that summarize the available literature regarding the development and use of RIRS in children.
Results:
RIRS as of today is well established as a superior modality for all stones in all locations compared to ESWL both in children and adults. The passive dilation have decreased the need of active ureteral dilation, but the need to perform pre-stenting is not defined yet. Regarding the use of the ureteral access sheath, the literature tends to lean towards its placement in most cases, but we do not know its long-term effects over the growth of children. Finally the stone free rate has increased as the experience of pediatric urologists increases, as well as the number of complications has decreased.
Conclusion:
RIRS in pediatrics has crossed many milestones , yet many areas need further research and larger data is required to make RIRS the procedure of choice for renal stone management in children across all age group.
