University Hospital Southampton NHS Trust, Southampton, United Kingdom.
Urology Department, Fundació Puigvert, Barcelona, Spain.
Urology. 2021 Nov;157:222-226. doi: 10.1016/j.urology.2021.04.011. Epub 2021 Apr 21.
To look at the safety and outcomes of using ureteral access sheath (UAS) for pediatric renal stones. The use of UAS is variable in urological practice with very little clinical work on their use in pediatric kidney stone disease.
Data was retrospectively collected from 2 large European tertiary endourology centers for all pediatric patients (≤16 years) with renal stones who underwent flexible ureteroscopy and lasertripsy (FURSL) via UAS. Data was collected on patient details, stone demographics and clinical outcomes of the FURSL procedure.
Forty-eight patients with a mean age of 10.7 years were treated with FURSL for a mean single and cumulative stone size of 10.4 mm and 15 mm respectively, with two-third having multiple stones and stones in the lower pole. The initial and final stone free rate (SFR) was 66.7% and 100% respectively with 1.3 procedures/patient. One patient each had intra-operative grade 1 ureteric injury and post-operative UTI, with no other injuries or complications noted. Over a mean follow-up of 17 months, no other complications were noted.
Ureteral access sheath is safe for treatment of pediatric renal stones with excellent outcomes and are especially useful for larger or multiple stones. While there does not seem to be any medium-term sequalae, to avoid risk of ureteral injury, we would suggest using the smallest size sheath possible. We would argue these procedures are best done in specialist high-volume endourology units for optimal results.
探讨输尿管导管（UAS）在小儿肾结石治疗中的安全性和效果。在泌尿外科实践中，UAS 的使用存在很大差异，而关于其在小儿肾结石疾病中的应用，临床研究工作很少。
本研究回顾性分析了 2 家大型欧洲三级泌尿外科内镜中心的所有接受输尿管镜下激光碎石术（FURSL）治疗的小儿肾结石（≤16 岁）患者的临床资料。收集了患者的详细信息、结石特征和 FURSL 手术的临床结果。
48 例平均年龄为 10.7 岁的患者接受了 FURSL 治疗，单次和累积结石大小分别为 10.4mm 和 15mm，其中三分之二的患者有多发结石和下极结石。初始和最终的无石率（SFR）分别为 66.7%和 100%，平均每个患者进行 1.3 次手术。术中各有 1 例患者出现 1 级输尿管损伤和术后尿路感染，无其他损伤或并发症。平均随访 17 个月，无其他并发症。
UAS 治疗小儿肾结石安全有效，尤其适用于较大或多发结石。虽然目前似乎没有中期并发症，但为了避免输尿管损伤的风险，我们建议使用最小尺寸的鞘管。我们认为，为了获得最佳效果，这些手术最好在专业的高容量泌尿外科内镜中心进行。
