The utility and safety of ureteral access sheath during retrograde intrarenal surgery in children

OBJECTIVES: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<0.001, p=0.021, p<0.001), 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<0.001). Group 1 had smaller stone diameter (9.91 +/- 4.46 vs 11.59 +/- 4.85 mm, p=0.001), shorter operation time (p=0.040), less stenting (35.7% vs 72.7%, p=0.003). Re-intervention rates and stone free rates (SFR) were similar between groups (p=0.5 & p=0.374). However, group 1 had significantly high re-RIRS (p=0.009). SFR had a positive correlation with smaller stone size and TFL usage compared to HFL (p<0.001 & p=0.020), but multivariate analysis revealed only large stone size as a risk factor for residual fragments (p=0.001). 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.