Safety and Outcomes of using ureteric access sheath (UAS) for treatment of Paediatric renal stones: Outcomes from 2 tertiary endourology centres.

OBJECTIVE To look at the safety and outcomes of using ureteral access sheath (UAS) for paediatric renal stones. The use of UAS is variable in urological practice with very little clinical work on their use in paediatric kidney stone disease. PATIENTS AND METHODS Data was retrospectively collected from two large European tertiary endourology centres for all paediatric 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. RESULTS 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 15mm 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. CONCLUSIONS Ureteral access sheath is safe for treatment of paediatric 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.