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RIRS affords good stone-free rate in paediatric cystine stone patients

11 Mar 2017

Retrograde intrarenal surgery (RIRS) appears to be a safe treatment modality in the management of paediatric cystine stones, yielding complete stone clearance and allowing repeat performance in recurrences, according to a retrospective study.

Researchers reviewed the medical records of 14 paediatric patients (mean age 10.9 years) who underwent RIRS for kidney stones (mean stone size 13.6 mm), with stones located in sites including the renal pelvis (n=4), lower (n=3), middle (n=3) or upper calyx (n=4).

Operative data indicated use of ureteral access sheath in 85.7 percent of patients, while placement of the double-J ureteral stent was preoperative in one patient and postoperative in 12. The operation time ranged between 30 to 50 minutes (mean, 38.2 min), with minimal complications such as mild ureteral laceration in one patient occurring during the procedure and fever in another patient occurring 2 days after the procedure.

Sonographic evaluation data showed all of the patients to be stone free at the 4-week follow-up. Potassium citrate was administered in 11 patients, and prophylactic tiopronin for recurrence was initiated in four patients during long-term follow-up. There was one incident of stone recurrence, which occurred during a mean follow-up period of 25.7 months.

Performed using a flexible ureterorenoscope, RIRS is used to remove smaller kidney stones and treat upper urinary tract tumours. The procedure is associated with fewer complications and less morbidity compared with percutaneous nephrolithotomy, the current gold standard treatment for kidney stones >2 cm. [Turk J Urol 2015;41:73–77; Biomed Res Int 2015;doi:10.1155/2015/914231]

RIRS represents an attractive treatment modality alternative to PNL, especially in the management of challenging-to-treat cystine stone patients who are at high risk of rapid recurrence in the presence of residual fragments, researchers said. “Besides allowing complete stone clearance, [the procedure] is a highly reproducible method that can be safely performed, even in recurrences.”

Some limitations to the study included the limited number of patients and short follow-up period.

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