Patrick Juliebø-Jones, Vineet Gauhar, Ee Jean Lim, Olivier Traxer, Yesica Quiroz Madarriaga, Daniele Castellani, Khi Yung Fong, Anna Bujons, Deepak Ragoori, Anil Shrestha, Chandra Mohan Vaddi, Tanuj Paul Bhatia, Cagri Akin Sekerci, Yiloren Tanidir, Jeremy Yuen-Chun Teoh, Bhaskar Kumar Somani
{"title":"儿童多发性巨大肾结石(>15 毫米)逆行肾内手术(RIRS)的疗效和注意事项:来自多中心和真实世界的研究结果","authors":"Patrick Juliebø-Jones, Vineet Gauhar, Ee Jean Lim, Olivier Traxer, Yesica Quiroz Madarriaga, Daniele Castellani, Khi Yung Fong, Anna Bujons, Deepak Ragoori, Anil Shrestha, Chandra Mohan Vaddi, Tanuj Paul Bhatia, Cagri Akin Sekerci, Yiloren Tanidir, Jeremy Yuen-Chun Teoh, Bhaskar Kumar Somani","doi":"10.1002/bco2.357","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>The aim of this study is to evaluate the outcomes of retrograde intra renal surgery (RIRS) in the setting of large or multiple stones in children (<18 years).</p>\n </section>\n \n <section>\n \n <h3> Materials and Methods</h3>\n \n <p>Retrospective analysis was performed of paediatric RIRS cases at nine centres worldwide over a 6-year period. Patients were divided into two groups: Group 1 had a single stone <15 mm. Group 2 had either multiple stones, maximum stone diameter of >15 mm, or both. Outcomes included stone free rate (SFR) and complications within 30 days.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>In total, 344 patients were included with 197 and 147 in Groups 1 and 2, respectively. Ureteric access sheaths were more frequently used in Group 2 (39.5% vs. 56.8%, <i>p</i> = 0.021). The operation time was significantly longer in Group 2 (<i>p</i> < 0.001). SFR after a single procedure was 84.7% in Group 1 and 63.7% in Group 2. Overall complication rates in Groups 1 and 2 were 7.6% and 33.3%, respectively. The most frequently reported complication in both groups was post-operative fever (4.4% vs. 14%, <i>p</i> = 0.004). The rate of Clavien I/II complications in groups 1 and 2 was 6% and 25.1%, respectively (<i>p</i> < 0.05). The rate of Clavien ≥ III complications in groups 1 and 2 was 1.6% and 8.1%, respectively (<i>p</i> < 0.05). On multivariate analysis, total operation time, stone size and multiplicity were significant predictors of residual fragments.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>RIRS can be performed in paediatric cases with large and multiple stone burdens, but the complication rate is significantly higher when compared to smaller stones.</p>\n </section>\n </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 6","pages":"558-563"},"PeriodicalIF":1.6000,"publicationDate":"2024-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.357","citationCount":"0","resultStr":"{\"title\":\"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\",\"authors\":\"Patrick Juliebø-Jones, Vineet Gauhar, Ee Jean Lim, Olivier Traxer, Yesica Quiroz Madarriaga, Daniele Castellani, Khi Yung Fong, Anna Bujons, Deepak Ragoori, Anil Shrestha, Chandra Mohan Vaddi, Tanuj Paul Bhatia, Cagri Akin Sekerci, Yiloren Tanidir, Jeremy Yuen-Chun Teoh, Bhaskar Kumar Somani\",\"doi\":\"10.1002/bco2.357\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Purpose</h3>\\n \\n <p>The aim of this study is to evaluate the outcomes of retrograde intra renal surgery (RIRS) in the setting of large or multiple stones in children (<18 years).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Materials and Methods</h3>\\n \\n <p>Retrospective analysis was performed of paediatric RIRS cases at nine centres worldwide over a 6-year period. Patients were divided into two groups: Group 1 had a single stone <15 mm. Group 2 had either multiple stones, maximum stone diameter of >15 mm, or both. Outcomes included stone free rate (SFR) and complications within 30 days.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>In total, 344 patients were included with 197 and 147 in Groups 1 and 2, respectively. Ureteric access sheaths were more frequently used in Group 2 (39.5% vs. 56.8%, <i>p</i> = 0.021). The operation time was significantly longer in Group 2 (<i>p</i> < 0.001). SFR after a single procedure was 84.7% in Group 1 and 63.7% in Group 2. Overall complication rates in Groups 1 and 2 were 7.6% and 33.3%, respectively. The most frequently reported complication in both groups was post-operative fever (4.4% vs. 14%, <i>p</i> = 0.004). The rate of Clavien I/II complications in groups 1 and 2 was 6% and 25.1%, respectively (<i>p</i> < 0.05). The rate of Clavien ≥ III complications in groups 1 and 2 was 1.6% and 8.1%, respectively (<i>p</i> < 0.05). On multivariate analysis, total operation time, stone size and multiplicity were significant predictors of residual fragments.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>RIRS can be performed in paediatric cases with large and multiple stone burdens, but the complication rate is significantly higher when compared to smaller stones.</p>\\n </section>\\n </div>\",\"PeriodicalId\":72420,\"journal\":{\"name\":\"BJUI compass\",\"volume\":\"5 6\",\"pages\":\"558-563\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-03-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.357\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BJUI compass\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/bco2.357\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BJUI compass","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/bco2.357","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
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
Purpose
The aim of this study is to evaluate the outcomes of retrograde intra renal surgery (RIRS) in the setting of large or multiple stones in children (<18 years).
Materials and Methods
Retrospective analysis was performed of paediatric RIRS cases at nine centres worldwide over a 6-year period. Patients were divided into two groups: Group 1 had a single stone <15 mm. Group 2 had either multiple stones, maximum stone diameter of >15 mm, or both. Outcomes included stone free rate (SFR) and complications within 30 days.
Results
In total, 344 patients were included with 197 and 147 in Groups 1 and 2, respectively. Ureteric access sheaths were more frequently used in Group 2 (39.5% vs. 56.8%, p = 0.021). The operation time was significantly longer in Group 2 (p < 0.001). SFR after a single procedure was 84.7% in Group 1 and 63.7% in Group 2. Overall complication rates in Groups 1 and 2 were 7.6% and 33.3%, respectively. The most frequently reported complication in both groups was post-operative fever (4.4% vs. 14%, p = 0.004). The rate of Clavien I/II complications in groups 1 and 2 was 6% and 25.1%, respectively (p < 0.05). The rate of Clavien ≥ III complications in groups 1 and 2 was 1.6% and 8.1%, respectively (p < 0.05). On multivariate analysis, total operation time, stone size and multiplicity were significant predictors of residual fragments.
Conclusions
RIRS can be performed in paediatric cases with large and multiple stone burdens, but the complication rate is significantly higher when compared to smaller stones.