Role of Pediatric Ureteral Access Sheath and Outcomes Related to Flexible Ureteroscopy and Laser Stone Fragmentation: A Systematic Review of Literature

Overview

Journal Eur Urol Open Sci

Date 2022 Oct 21

PMID 36267473

Authors

Francesco Ripa

Theodoros Tokas

Stephen Griffin

Stefania Ferretti

Anna Bujons Tur

Bhaskar K Somani

Affiliations

Soon will be listed here.

Abstract

Context: Flexible ureteroscopy and laser lithotripsy (FURSL) represent a good treatment option for pediatric urolithiasis. Scarce evidence is available about the safety and efficacy of the concomitant use of a ureteral access sheath (UAS) in the setting of pediatric ureteroscopy (URS).

Objective: To acquire all the available evidence on UAS usage in pediatric FURSL, focusing on intra- and postoperative complications and stone-free rates (SFRs).

Evidence Acquisition: We performed a systematic literature research using PubMed/MEDLINE, Embase, and Scopus databases. The inclusion criteria were cohorts of pediatric patients <18 yr old, submitted to URS for FURSL, reporting on more than ten cases of UAS placement. The primary outcomes were prestenting rates, operating time, ureteric stent placement rates after surgery, rates and grades of complications, ureteral injuries, and overall SFR. A total of 22 articles were selected.

Evidence Synthesis: In total, 26 intraoperative and 130 postoperative complications following URS with UAS placement were reported (1.8% and 9.18% of the overall procedures, respectively). According to the Clavien-Dindo classification, 32 were classified as Clavien I, 29 as Clavien II, 43 as Clavien I or II, six as Clavien III, and one as Clavien IV. Twenty-one cases of ureteral injuries (1.59%) were noted in the whole cohort; most of them were ureteral perforation or extravasation, and were treated with a temporary indwelling ureteric stent. The overall SFR after a single URS procedure was 76.92%; after at least a second procedure, it was 84.9%.

Conclusions: FURSL is a safe and effective treatment option for pediatric urolithiasis. UAS use was associated with a low rate of ureteric injuries, mostly treated and resolved with a temporary indwelling ureteric stent.

Patient Summary: We performed a systematic literature research on the utilization of a UAS during ureteroscopy for stone treatment in pediatric patients. We assessed the outcomes related to the rates of intra- and postoperative complications and the rates of efficacy of the procedure in the clearance of stones. The evidence shows a low rate and grade of complications associated with UAS placement and good stone-free outcomes. A ureteric injury may occur in 1.6% of cases, but it is usually managed and resolved with a temporary indwelling ureteric stent.

Citing Articles

Comparison of flexible and navigable suction ureteral access sheath with conventional ureteral access sheath for pediatric retrograde intrarenal surgery: a single-center propensity-matched analysis.

Turedi B, Sezer A Urolithiasis. 2024; 53(1):17.

PMID: 39738883 DOI: 10.1007/s00240-024-01686-w.

Is flexible and navigable suction ureteral access sheath (FANS-UAS) the next best development for retrograde intrarenal surgery in children? Results of a prospective multicentre study.

Gauhar V, Madarriaga Y, Somani B, Joshi R, Tanidir Y, Castellani D World J Urol. 2024; 42(1):627.

PMID: 39503864 DOI: 10.1007/s00345-024-05337-y.

International Alliance of Urolithiasis (IAU) guidelines on the management of pediatric urolithiasis.

Zeng G, Zhu W, Somani B, Choong S, Straub M, Maroccolo M Urolithiasis. 2024; 52(1):124.

PMID: 39230669 DOI: 10.1007/s00240-024-01621-z.

Utilization of Flexible Ureteroscopy in Renal Stones Management in Pediatrics: Single Tertiary Center Experience.

Elbakary M, Alruwaili S Glob Pediatr Health. 2023; 10:2333794X231199637.

PMID: 37809363 PMC: 10559721. DOI: 10.1177/2333794X231199637.

Cystine Stones: Developments in Minimally Invasive Surgery and Their Impact on Morbidity and Stone Clearance.

Hughes T, Tzelves L, Somani B Res Rep Urol. 2023; 15:175-185.

PMID: 37303487 PMC: 10254682. DOI: 10.2147/RRU.S381190.

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