To look at the safety and outcomes of using ureteral access sheath (UAS) for paediatric renal stones. The use of UAS is variable in urological practice with very little clinical work on their use in paediatric kidney stone disease.
Data was retrospectively collected from two large European tertiary endourology centres for all paediatric patients (≤16 years) with renal stones who underwent flexible ureteroscopy and lasertripsy (FURSL) via UAS. Data was collected on patient details, stone demographics and clinical outcomes of the FURSL procedure.
Forty-eight patients with a mean age of 10.7 years were treated with FURSL for a mean single and cumulative stone size of 10.4 mm and 15mm respectively, with two-third having multiple stones and stones in the lower pole. The initial and final stone free rate (SFR) was 66.7% and 100% respectively with 1.3 procedures/patient. One patient each had intra-operative grade 1 ureteric injury and post-operative UTI, with no other injuries or complications noted. Over a mean follow-up of 17 months, no other complications were noted.
Ureteral access sheath is safe for treatment of paediatric renal stones with excellent outcomes and are especially useful for larger or multiple stones. While there does not seem to be any medium-term sequalae, to avoid risk of ureteral injury, we would suggest using the smallest size sheath possible. We would argue these procedures are best done in specialist high-volume endourology units for optimal results.
Urology. 2021 Apr 20 [Epub ahead of print]
L Mosquera, A Pietropaolo, A Brewin, Y Q Madarriaga, E L de Knecht, P Jones, A Bujons, S Griffin, B K Somani
Clinical Fellow, University Hospital Southampton NHS Trust, Southampton, UK. Electronic address: ., Associate Specialist, University Hospital Southampton NHS Trust, Southampton, UK. Electronic address: ., Clinical Fellow, University Hospital Southampton NHS Trust, Southampton, UK. Electronic address: ., Research and Clinical Fellow of Pediatric Urology Unit, Urology Department, Fundació Puigvert, Barcelona, Spain. Electronic address: ., Associate Specialist Urology Department, Fundació Puigvert, Barcelona, Spain. Electronic address: ., Speciality trainee, University Hospital Southampton NHS Trust, Southampton, UK. Electronic address: ., Chief of Pediatric Urology Unit, Urology Department, PhD, FEAPU, Fundació Puigvert, Barcelona, Spain. Electronic address: ., Consultant Paediatric Urologist, Southampton Children's Hospital NHS Trust, Southampton, UK. Electronic address: ., Professor and Consultant Urological Surgeon, University Hospital Southampton NHS Trust, Southampton, UK. Electronic address: .