The Utility and Safety of Ureteral Access Sheath During Retrograde Intrarenal Surgery in Children

OBJECTIVE To compare retrograde intrarenal surgery (RIRS) with and without ureteral access sheath (UAS) in different pediatric age groups. METHODS The data of RIRS for kidney stone in children were obtained from 9 institutions. Demographic characteristics of patients and stones, intraoperative and postoperative results were recorded. While analyzing the data, patients who underwent RIRS without UAS (group 1) (n = 195) and RIRS with UAS (group 2) (n = 194) were compared. RESULTS Group 1 was found to be young, thin, and short ( P < .001, P = .021, P < .001), but there was no gender difference and similar symptoms were present except hematuria, which was predominant in group 2 (10.6% vs 17.3%, P < .001). Group 1 had smaller stone diameter (9.91 +/- 4.46 vs 11.59 +/- 4.85 mm, P = .001), shorter operation time ( P = .040), less stenting (35.7% vs 72.7%, P = .003). Re-intervention rates and stone-free rates (SFR) were similar between groups ( P = .5 and P = .374). However, group 1 had significantly high re-RIRS ( P = .009). SFR had a positive correlation with smaller stone size and thulium fiber laser usage compared to holmium fiber laser (HFL) ( P < .001 and P = .020), but multivariate analysis revealed only large stone size as a risk factor for residual fragments ( P = .001). CONCLUSION RIRS can be performed safely in children with and without UAS. In children of smaller size or younger age (< 5 years), limited use of UAS was observed. UAS may be of greater utility in stones larger than 1 cm, regardless of the age, and using smaller diameter UAS and ureteroscopes can decrease the complications. (c) 2024 Elsevier Inc. All rights reserved.