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Role of Preoperative Ureteral Stent on Outcomes of Retrograde Intra-Renal Surgery (RIRS) in Children. Results From a
Daniele Castellani1, Bhaskar Kumar Somani2, Stefania Ferretti3
1Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy.
Insights
Pre-stenting in pediatric retrograde intrarenal surgery (RIRS) did not improve stone-free rates but increased infection risk. This study compared outcomes in children undergoing RIRS with or without ureteral pre-stenting.
Area of Science:
- Pediatric Urology
- Endourology
- Nephrolithiasis Management
Background:
- Retrograde intrarenal surgery (RIRS) is a common treatment for pediatric kidney stones.
- The use of ureteral pre-stenting in RIRS for children is debated.
- Assessing pre-stenting outcomes is crucial for optimizing pediatric stone treatment.
Purpose of the Study:
- To compare the outcomes of pre-stenting versus non-pre-stenting in children undergoing RIRS for intrarenal stones.
- To evaluate stone-free status, surgical time, and complication rates between the two groups.
- To identify factors associated with residual fragments after RIRS in pediatric patients.
Main Methods:
- Retrospective review of 389 children/adolescents undergoing RIRS across 9 centers (2015-2020).
- Patients were divided into non-prestented (Group 1) and prestented (Group 2) groups.
- Statistical analysis included Student's t-test, Chi-square, Fisher's exact test, and logistic regression.
Main Results:
- No significant difference in stone-free rates (30.7% vs 26.4%) between non-prestented and prestented groups.
- Pre-stented patients were younger (8.3 vs 10.4 years) but had a higher incidence of urinary tract infections (10.7% vs 3.7%).
- Stone size was a significant predictor of residual fragments (OR 1.20).
Conclusions:
- Pre-stenting does not improve stone-free rates in pediatric RIRS.
- Pre-stenting is associated with an increased risk of post-operative infections in children.
- Stone size remains a key factor influencing treatment success in pediatric RIRS.
Objective:
To assess outcomes of pre-stenting versus non-pre-stenting in children undergoing retrograde intrarenal surgery (RIRS) for intrarenal stones.
Methods:
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.
Results:
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).
Conclusions:
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.
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