Retrograde intrarenal surgery for renal stones in children <5 years of age

Abstract

Introduction: There are very few studies in the literature describing retrograde intrarenal surgery (RIRS) in preschool children. We have evaluated the feasibility, stone-free rate, and complications of RIRS in children <5 years of age. Methods: All children <5 years of age and stone size <2 cm (renal/proximal ureteric), who underwent RIRS at our hospital from February 2010 to May 2020 were included in this retrospective study. All children were prestented for the passive dilatation of ureter. A 7.5 Fr flexible ureterorenoscope was introduced over the ureteral access sheath (UAS) or over a guidewire. At 2 weeks, the stent was removed and at 2 months the child was evaluated for residual stones. Results: A total of 62 children with 67 renal units met the inclusion criteria. The mean age was 42.11 months (4–60 months). Mean weight was 13.31 kg (6–16.3 kg). Mean stone size was 11.9 mm (7.3–18.2 mm). Majority of the stones were in pelvis (37.8%). UAS 9.5/11.5 Fr was placed in 40 (63.5%) children. Mean operative time was 55.2 min; mean hospitalization was 61 h. Four out of the 67 renal units (5.9%) required conversion to minipercutaneous nephrolithotomy in the same sitting, due to access failure. Two cases who developed post-operative fever required a change of antibiotics. Two cases required ureteroscopy for steinstrasse postoperatively. Stone-free rate at 2 months for stones size =2 mm was 76.3%. Conclusion: Pediatric RIRS is a promising option in young children as it offers acceptable stone-free rates and a low incidence of high-grade complications. However, it requires expertise and should be offered in tertiary care centres.