Role of Preoperative Ureteral Stent on Outcomes of Retrograde Intra-Renal Surgery (RIRS) in Children. Results From a Comparative, Large, Multicenter Series

To assess outcomes of pre-stenting versus non-pre-stenting in children undergoing retrograde intrarenal surgery (RIRS) for intrarenal stones. Children/adolescent with kidney stones undergoing RIRS in 9 centers between 2015 and 2020 were retrospectively reviewed. Exclusion criteria: ureteral lithotri...

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Published in:	Urology (Ridgewood, N.J.) Vol. 173; pp. 153 - 158
Main Authors:	Castellani, Daniele, Somani, Bhaskar Kumar, Ferretti, Stefania, Gatti, Claudia, Sekerci, Cagri Akin, Madarriaga, Yesica Quiroz, Fong, Khi Yung, Campobasso, Davide, Ragoori, Deepak, Shrestha, Anil, Vaddi, Chandra Mohan, Bhatia, Tanuj Paul, Sinha, Mriganka Mani, Lim, Ee Jean, Teoh, Jeremy Yuen‑Chun, Griffin, Stephen, Tur, Anna Bujon, Tanidir, Yiloren, Traxer, Olivier, Gauhar, Vineet
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-03-2023
Subjects:	Adolescent Child Child, Preschool Humans Kidney - surgery Kidney Calculi - surgery Retrospective Studies Stents Treatment Outcome Ureter - surgery
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Summary:	To assess outcomes of pre-stenting versus non-pre-stenting in children undergoing retrograde intrarenal surgery (RIRS) for intrarenal stones. Children/adolescent with kidney stones undergoing RIRS in 9 centers between 2015 and 2020 were retrospectively reviewed. Exclusion criteria: ureteral lithotripsy, bilateral procedures. Stone-free status was evaluated at 3-month and defined as a single residual fragment (RF) ≤2 mm/absence of multiple fragments. Patients were divided into two groups (Group 1 no-prestenting; Group 2 prestenting). Student's, Chi-square and Fisher's exact test was used to assess difference between groups. Univariable and multivariable logistic regression analysis were performed to predict RF. Statistical significance: P-value <0.05. Three hundred eighty-nine children/adolescents were included (192 patients in Group 1). Prestented patients were younger compared with non-prestented (mean age 8.30 ± 4.93 vs 10.43 ± 4.30 years, P < 0.001). There were no differences in stone characteristics (number, size, locations). Lasing and total surgical time were similar. Urinary tract infections were more prevalent in Group 2 (10.7%) compared to Group 1 (3.7%, P = 0.016). Sepsis occurred in 2.1% of patients in Group 2 and no patient in Group 1 (P = 0.146). 30.7% patients in Group 1 and 26.4% in Group 2 had RF (P = 0.322). In univariate logistic regression analysis, stone size was associated with RF (OR 1.12 95%CI 1.06-1.18, P < 0.001), whereas Thulium fiber laser with a lower incidence (OR 0.24 95%CI 0.06-0.69, p=0.020). Multivariate logistic regression analysis showed that stone size was associated with RF (OR 1.20 95%CI 1.08-1.36, P = 0.001). RIRS showed similar stone-free rate in pre and non-prestented children/adolescents, although prestented patients were younger. A higher risk of post-operative infections was reported in prestented patients.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0090-4295 1527-9995
DOI:	10.1016/j.urology.2022.11.019