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Retrograde intrarenal surgery for the treatment of renal stones in children: factors influencing stone clearance and complications.
[cystinuria]
Retrograde
intrarenal
surgery
(
RIRS
)
is
a
known
option
for
the
treatment
of
upper
tract
calculi
with
an
excellent
success
.
However
,
the
reports
of
RIRS
in
prepubertal
children
are
limited
.
In
this
study
,
we
evaluated
the
factors
which
affected
the
success
rate
and
the
complications
of
RIRS
at
renal
stone
treatment
in
childhood
.
We
retrospectively
reviewed
the
records
of
children
under
14
years
old
who
underwent
RIRS
for
renal
stone
disease
between
January
2009
and
December
2012
.
Patients
'
age
,
gender
,
body
mass
index
(
BMI
)
,
stone
size
,
stone
location
,
stone
number
,
intraoperative
complications
,
stone
free
status
,
postoperative
complications
were
recorded
.
There
were
80
ureterorenoscopic
procedures
performed
in
58
renal
units
of
47
children
(
23
males
and
24
females
)
.
The
patients
'
ages
ranged
from
8
months
to
14
years
(
mean
age
4
.
7
±
3
.
4
years
)
.
There
was
a
difference
in
the
distribution
of
symptoms
in
age
groups
.
UTI
was
higher
in
the
1
-
4
years
age
group
,
abdominal
pain
was
seen
mostly
in
children
aged
5
-
14
years
.
Multiple
stones
(
included
staghorn
stone
)
were
noted
in
60
.
4
%
of
patients
.
In
27
.
6
%
of
patients
,
ureteral
stones
were
accompanied
by
renal
stones
in
our
series
.
In
the
infancy
group
,
cystine
and
staghorn
stones
were
more
frequently
seen
,
mostly
bilateral
.
After
a
single
ureteroscopic
procedure
for
intrarenal
stones
in
children
,
we
achieved
stone
free
status
in
50
.
9
%
of
the
ureters
(
n
=
26
)
.
After
the
repeated
sessions
,
the
stone
clearance
rate
reached
to
85
.
1
%
.
Retrograde
intrarenal
surgery
can
be
used
as
a
first
line
therapy
to
treat
renal
stones
in
children
.
This
is
especially
important
if
an
associated
ureteral
stone
is
present
that
requires
treatment
;
or
in
patients
with
cystinuria
,
which
is
not
favorably
treated
with
ESWL
.
Complications
were
seen
more
frequently
in
patients
with
cystine
stones
.
Extravasation
was
noted
more
frequently
in
patients
admitted
with
UTIs
.
There
was
a
significant
relationship
between
the
conversion
to
open
procedures
and
the
age
groups
,
with
most
procedures
occurring
in
infancy
.
The
parents
should
be
informed
about
the
probability
of
multiple
procedures
to
achieve
stone
free
status
.
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