Outcomes and considerations for retrograde intrarenal surgery (RIRS) in the setting of multiple and large renal stones (>15 mm) in children: Findings from multicentre and real‐world setting
Patrick Juliebø‐Jones,
Vineet Gauhar,
Ee Jean Lim,
Olivier Traxer,
Yesica Quiroz Madarriaga,
Daniele Castellani,
Khi Yung Fong,
Anna Bujons,
Deepak Ragoori,
Anil Shrestha,
Chandra Mohan Vaddi,
Tanuj Paul Bhatia,
Cagri Akin Sekerci,
Yiloren Tanidir,
Jeremy Yuen‐Chun Teoh,
Bhaskar Kumar Somani
Affiliations
Patrick Juliebø‐Jones
Department of Clinical Medicine University of Bergen Bergen Norway
Vineet Gauhar
Department of Urology Ng Teng Fong Hospital Singapore Singapore
Ee Jean Lim
Department of Urology Singapore General Hospital Singapore Singapore
Olivier Traxer
Department of Urology Hôpital Tenon Sorbonne University Paris France
Yesica Quiroz Madarriaga
Urology Department Autonomous University of Barcelona, Fundació Puigvert Barcelona Spain
Daniele Castellani
Urology Division, Azienda Ospedaliero‐Universitaria Ospedali Riuniti Di Ancona Università Politecnica Delle Marche Ancona Italy
Khi Yung Fong
Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
Anna Bujons
Urology Department Autonomous University of Barcelona, Fundació Puigvert Barcelona Spain
Deepak Ragoori
Department of Urology Asian Institute of Nephrology and Urology, Banjara Hills Hyderabad India
Anil Shrestha
Department of Urology, National Academy of Medical Sciences Bir Hospital Kathmandu Nepal
Chandra Mohan Vaddi
Department of Urology Preeti Urology and Kidney Hospital Hyderabad India
Tanuj Paul Bhatia
Department of Urology Sarvodaya Hospital Sarvodaya Guwahati India
Cagri Akin Sekerci
Department of Urology Marmara University School of Medicine Istanbul Turkey
Yiloren Tanidir
Department of Urology Marmara University School of Medicine Istanbul Turkey
Jeremy Yuen‐Chun Teoh
Department of Surgery, S.H. Ho Urology Centre The Chinese University of Hong Kong Sha Tin Hong Kong, China
Bhaskar Kumar Somani
Department of Urology University Hospital Southampton Southampton UK
Abstract Purpose The aim of this study is to evaluate the outcomes of retrograde intra renal surgery (RIRS) in the setting of large or multiple stones in children (15 mm, or both. Outcomes included stone free rate (SFR) and complications within 30 days. Results In total, 344 patients were included with 197 and 147 in Groups 1 and 2, respectively. Ureteric access sheaths were more frequently used in Group 2 (39.5% vs. 56.8%, p = 0.021). The operation time was significantly longer in Group 2 (p < 0.001). SFR after a single procedure was 84.7% in Group 1 and 63.7% in Group 2. Overall complication rates in Groups 1 and 2 were 7.6% and 33.3%, respectively. The most frequently reported complication in both groups was post‐operative fever (4.4% vs. 14%, p = 0.004). The rate of Clavien I/II complications in groups 1 and 2 was 6% and 25.1%, respectively (p < 0.05). The rate of Clavien ≥ III complications in groups 1 and 2 was 1.6% and 8.1%, respectively (p < 0.05). On multivariate analysis, total operation time, stone size and multiplicity were significant predictors of residual fragments. Conclusions RIRS can be performed in paediatric cases with large and multiple stone burdens, but the complication rate is significantly higher when compared to smaller stones.
