Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore.
Department of Urology, Fundació Puigvert, Carrer de Cartagena, 340-350, Barcelona, 08025, Spain.
World J Urol. 2024 Nov 6;42(1):627. doi: 10.1007/s00345-024-05337-y.
To assess retrograde intrarenal surgery (RIRS) outcomes in children using ClearPetra, a flexible and navigable suction ureteral access sheath (FANS-UAS).
Children with kidney stone(s) only undergoing RIRS in 8 centers were prospectively included (September 2023-May 2024).
ureteral stone, bilateral procedures, anomalous kidneys, surgery for residual fragments. Lithotripsy was performed using either a Holmium or Thulium fiber laser. Postoperative pain was assessed within 24 h using a 10-point visual analogue score. The use of FANS-UAS was graded by surgeons after each case using a 5-point likert scale. Low-dose non-contrast CT scan was performed before and within 30 days of RIRS to assess residual fragments (RFs). Stone-free status was defined as no RF or single RF up to 2 mm.
50 children were included. 66% were male. Mean age was 6.6 (± 3.38) years. 88% stones were < 2 cm. one-third of the patients had a stone volume > 1500mm. 10-12 Fr FANS-UAS was used in 98% of the procedure. The mean operative time was 46.02 (± 20.72) minutes. 2 patients had Traxer grade1 distal ureter and 2 forniceal injuries on sheath placement. Mean pain score was 2.18 (± 1.34). Mean likert scale was 1.16 (± 0.47) for ease of suction, 1.24 (± 0.52) for manipulation, 1.02 (± 0.32) for visibility. 4 patients had post-operative fever lasting less than 24 h. No sepsis occurred. Stone-free rate was 100%.
Our study shows that the use of FANS-UAS in paediatric RIRS is feasible and safe with a low rate of complications and excellent stone-free rate.
评估使用可弯曲、可导航的抽吸输尿管接入鞘（FANS-UAS）行逆行肾内手术（RIRS）治疗儿童肾结石的效果。
8 家中心前瞻性纳入仅接受 RIRS 的肾结石儿童患者（2023 年 9 月至 2024 年 5 月）。
输尿管结石、双侧手术、异常肾脏、残石手术。碎石采用钬激光或铥光纤激光。术后 24 小时内采用 10 分制视觉模拟评分评估术后疼痛。每位患者手术后，术者采用 5 分 Likert 量表对 FANS-UAS 的使用进行分级。RIRS 术前和术后 30 天内行低剂量非增强 CT 扫描评估残石（RFs）。无 RF 或单个最大直径不超过 2mm 的 RF 定义为结石清除。
共纳入 50 例患儿，66%为男性，平均年龄 6.6（±3.38）岁，88%的结石<2cm，1/3 的患者结石体积>1500mm³。98%的患者使用 10-12Fr FANS-UAS。平均手术时间为 46.02（±20.72）分钟，2 例患者在鞘管置入时出现 TraxerⅠ级远端输尿管损伤，2 例出现穹窿损伤。平均疼痛评分为 2.18（±1.34），Likert 量表评分中，抽吸的舒适度评分为 1.16（±0.47），操作的便利性评分为 1.24（±0.52），可视性评分为 1.02（±0.32）。4 例患者术后发热持续时间<24 小时，无脓毒症发生。结石清除率为 100%。
本研究表明，在儿科 RIRS 中使用 FANS-UAS 是可行且安全的，并发症发生率低，结石清除率高。
