Role of Pediatric Ureteral Access Sheath and Outcomes Related to Flexible Ureteroscopy and Laser Stone Fragmentation : A Systematic Review of Literature
Ripa, Francesco (University Hospital Southampton NHS Foundation Trust (Regne Unit))
Tokas, Theodoros (Training and Research in Urological Surgery and Technology (T.R.U.S.T.) Group)
Griffin, Stephen (University Hospital Southampton NHS Foundation Trust (Regne Unit))
Ferretti, Stefania (Hospital and University of Parma)
Bujons, Anna (Institut d'Investigació Biomèdica Sant Pau)
Somani, Bhaskar K. (University Hospital Southampton NHS Foundation Trust (Regne Unit))
Universitat Autònoma de Barcelona

Date:	2022
Abstract:	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). To acquire all the available evidence on UAS usage in pediatric FURSL, focusing on intra- and postoperative complications and stone-free rates (SFRs). 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%. 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. 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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Access sheath ; Kidney calculi ; Laser ; Pediatric ; Ureteral access sheath ; Ureteroscopy
Published in:	European Urology Open Science, Vol. 45 (november 2022) , p. 90-98, ISSN 2666-1683

DOI: 10.1016/j.euros.2022.09.012
PMID: 36267473

9 p, 751.0 KB

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