EAU 2018: Our Technique of Retrograde Intrarenal Surgery in Less Than 5-Year-Old Children

Copenhagen, Denmark (UroToday.com) Nephrolithiasis is a common problem affecting 1 in 11 adults in the world. The incidence of pediatric nephrolithiasis has also been on the rise. Management of kidney stones in children poses a significant challenge. Due to high recurrence rates and potential of multiple procedures poses these children at high risk of chronic kidney disease and ultimately renal failure if not treated properly. 

Percutaneous and endoscopic procedures are currently the standard of care. However, in children it is preferred to avoid percutaneous procedure as to not to put a hole in the kidney as this may potentially cause debilitating outcomes. 

Dr. Chandra Mohan Vaddi from the Preeti Urology & Kidney Hospital in Hyderabad India presented his video presentation on retrograde intrarenal surgery performed in children under the age of 5. As an introduction to his talk, Dr. Vaddi explained that the incidence of renal stones has been on the rise in pediatric patients and that Retrograde intra-renal surgery has been shown to be a good option for treatment with low morbidity and high stone free rates. 

Dr. Vaddi presented 2 cases where both patients pre-stented and underwent retrograde intra-renal surgery. The first was a 1 year old female child with a 1.2cm left renal stone (HU 1100). In the beginning rigid ureteroscopy was performed and a guide wire was placed up the ureter. The rigid scope was removed and a Karl Storz Flex X2 ureteroscope was placed over the guide wire under fluoroscopic guidance with no access sheath used. Once in place, a holmium laser fiber was inserted, and the stone was dusted at 0.8J and 10Hz. Laser settings was reduced as the stone got smaller. At the end of the case, a double-j stent was placed.

The second case was a 4-year old male with 5mm middle calyx stone and 1.3cm right pelvic stone. Similar to the first case, a Karl Storz Flex X2 ureteroscope was used with a holmium laser fiber at the same settings. Dr. Vaddi stated that both patients were stone-free with no complications post-procedure.

Dr. Vaddi concluded that retrograde intra-renal surgery can be done successfully in pediatric stone patients under the age of five with complete stone clearance. This method allows to manage the stone and render the patient stone free and avoid potential harm to the kidney. This is highly important in pediatric patients with potentially high risk of recurrent urolithiasis.

Presented by: Chandra Mohan Vaddi

Co-Authors: Paidakula R., Pashyakanti Mata S.S.
Author Information: Preeti Urology & Kidney Hospital, Dept. of Urology, Hyderabad, India 

Written by: Renai Yoon and Zhamshid Okunov, Department of Urology, University of California-Irvine at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark

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