Safety and efficacy of retrograde intrarenal surgery (RIRS) in pediatric patients: Insights from a single-center study

Abstract

Background:

Pediatric urolithiasis is increasingly managed with minimally invasive approaches. Retrograde Intrarenal Surgery (RIRS) offers a promising treatment option, though data on its outcomes in children remain limited.

Objective:

To evaluate the safety, efficacy, and predictors of outcomes following Retrograde Intrarenal Surgery (RIRS) in pediatric patients with renal or upper urinary tract stones.

Methods:

From September 2022 to August 2024, retrospective observational research was carried out at the Pakistan Kidney and Liver Institute and Research Center in Lahore. Included were pediatric patients (less than 14 years old) who had RIRS for upper tract or renal stones up to 27 mm. Demographics, stone features, surgical parameters, complications, and follow-up imaging results were among the data that were taken from electronic medical records. Statistical analysis was performed using SPSS v27; multivariate logistic regression identified predictors of postoperative complications and stone clearance.

Results:

A total of 24 pediatric patients underwent RIRS. Mean age was 9.0 ± 4.27 years; 18 (75.0%) were male. Stones were more often left-sided (14/24, 58.3%) and commonly located at multiple sites (11/24, 45.8%). RIRS was the primary treatment in 17 (70.8%) patients. Complete stone clearance was achieved in 17 (70.8%); access failure occurred in 4 (16.7%). Postoperative complications occurred in 5 (20.8%), including sepsis in 4 (16.7%). Anatomical abnormalities were seen in 5 (20.8%). Multivariate analysis showed anatomical abnormalities were protective against complications (p = 0.037), while stone size >15 mm significantly reduced clearance odds (p = 0.009). The predictive model for clearance was significant (p = 0.013, R² = 0.519).

Conclusion:

RIRS is a safe and effective treatment modality for pediatric urolithiasis, achieving high stone-free rate with minimal complications. Anatomical abnormalities may reduce risk of complications, while larger stone size negatively impacts clearance. These findings support the selective use of RIRS in children with careful preoperative evaluation to optimize outcomes.

Keywords

pediatric urolithiasis retrograde intrarenal surgery (RIRS)stone clearance postoperative complications access sheath failure

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References

Önal

Kırlı

EA.

Pediatric stone disease: current management and future concepts. Turk Arch Pediatr 2021; 56(2): 99–107.

Jobs

Rakowska

Paturej

Urolithiasis in the pediatric population - current opinion on epidemiology, pathophysiology, diagnostic evaluation and treatment. Dev Period Med 2018; 22(2): 201–208.

Ferretti

Cuschera

Campobasso

, et al. Rigid and flexible ureteroscopy (URS/RIRS) management of paediatric urolithiasis in a not endemic country. Arch Ital Urol Androl 2021; 93(1): 26–30.

Muslumanoglu

Tefekli

Sarilar

, et al. Extracorporeal shock wave lithotripsy as first line treatment alternative for urinary tract stones in children: a large scale retrospective analysis. J Urol 2003; 170(6 1): 2405–2408.

Unsal

Resorlu

Kara

, et al. Safety and efficacy of percutaneous nephrolithotomy in infants, preschool age, and older children with different sizes of instruments. Urology 2010; 76(1): 247–252.

Ishii

Griffin

Somani

BK.

Flexible ureteroscopy and lasertripsy (FURSL) for paediatric renal calculi: results from a systematic review. J Pediatr Urol 2014; 10(6): 1020–1025.

Anbarasan

Griffin

Somani

BK.

Outcomes and long-term follow-up with the use of ureteral access sheath for pediatric ureteroscopy and stone treatment: results from a tertiary endourology center. J Endourol 2019; 33(2): 79–83.

European Association of Urology. EAU guidelines on paediatric urology 2022 [Internet]. Available from: https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Paediatric-Urology-2022.pdf. (accessed October 2024).

Berrettini

Boeri

Montanari

, et al. Retrograde intrarenal surgery using ureteral access sheaths is a safe and effective treatment for renal stones in children weighing <<20 kg. J Pediatr Urol 2018; 14(1): 59.e1–59.e6.

10.

Mosquera

Pietropaolo

Brewin

, et al. Safety and outcomes of using ureteric access sheath (UAS) for treatment of pediatric renal stones: outcomes from 2 tertiary endourology centers. Urology 2021; 157: 222–226.

11.

Chen

Deng

Duan

, et al. Percutaneous nephrolithotomy versus retrograde intrarenal surgery for pediatric patients with upper urinary stones: a systematic review and meta-analysis. Urolithiasis 2019; 47(2): 189–199.

12.

Mokhless

Abdeldaeim

Saad

, et al. Retrograde intrarenal surgery monotherapy versus shock wave lithotripsy for stones 10 to 20 mm in preschool children: a prospective, randomized study. J Urol 2014; 191(5): 1496–1499.

13.

Xiao

Chen

, et al. Which is the best treatment of pediatric upper urinary tract stones among extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery: a systematic review. BMC Urol 2019; 19(1): 98.

14.

Mosquera

Pietropaolo

Madarriaga

, et al. Is flexible ureteroscopy and laser lithotripsy the new gold standard for pediatric lower pole stones? Outcomes from two large European tertiary pediatric endourology centers. J Endourol 2021; 35(10): 1479–1482.

15.

von Elm

Altman

Egger

, et al. The strengthening the reporting of observational studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61(4): 344–349.

16.

Thangavelu

Sawant

Sayed

, et al. Retrograde intrarenal surgery (RIRS) for upper urinary tract stones in children below 12 years of age: a single centre experience. Arch Ital Urol Androl 2022; 94(2): 190–194.

17.

Rosière

Ruiz

López Imizcoz

, et al. Predictive variables for successful retrograde intrarenal surgery outcomes in pediatric patients: development of nomograms. J Pediatr Urol 2025; 21: 775–776.

18.

Kahraman

Dogan

Asci

, et al. Factors associated with the stone-free status after retrograde intrarenal surgery in children. Int J Clin Pract 2021; 75(10): e14667.

19.

Gatti

Cerchia

Della Corte

, et al. Retrograde intrarenal surgery for renal stones: is it a safe and effective option in preschool children? J Pediatr Surg 2024; 59(3): 407–411.

20.

Sen

Baydilli

Ozturk

, et al. Factors effecting the success of retrograde intrarenal surgery in pediatric patients with renal stones: the experience of two tertiary centres with 368 renal units. J Pediatr Urol 2024; 20(3): 403.e1–403.e9.

21.

Ozkent

Piskin

Balasar

, et al. Is retrograde intrarenal surgery as safe for children as it is for adults? Urol Int 2021; 105(11-12): 1039–1045.

22.

Juliebø-Jones

Gauhar

Lim

, et al. Outcomes and considerations for retrograde intrarenal surgery (RIRS) in the setting of multiple and large renal stones (>15 mm) in children: findings from multicentre and real-world setting. BJUI Compass 2024; 5(12): 1324–1329.