Role of Pediatric Ureteral Access Sheath and Outcomes Related to Flexible Ureteroscopy and Laser Stone Fragmentation: A Systematic Review of Literature
Por:
Ripa, F, Tokas, T, Griffin, S, Ferretti, S, Tur, AB, Somani, BK
Publicada:
1 nov 2022
Ahead of Print:
1 oct 2022
Resumen:
Context: Flexible ureteroscopy and laser lithotripsy (FURSL) represent a good treat-ment 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). Objective: To acquire all the available evidence on UAS usage in pediatric FURSL, focusing on intra-and postoperative complications and stone-free rates (SFRs). Evidence acquisition: 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, operat-ing time, ureteric stent placement rates after surgery, rates and grades of compli-cations, 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 sin-gle URS procedure was 76.92%; after at least a second procedure, it was 84.9%. Conclusions: 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. Patient summary: 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. (c) 2022 Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).
Filiaciones:
Ripa, F:
Univ Hosp Southampton NHS Fdn Trust, Southampton, England
Tokas, T:
Gen Hosp Hall In Tirol, Dept Urol & Androl, Hall In Tirol, Austria
Training & Res Urol Surg & Technol TRUST Grp, Hall In Tirol, Austria
Griffin, S:
Univ Hosp Southampton NHS Fdn Trust, Southampton, England
Ferretti, S:
Hosp & Univ Parma, Parma, Italy
Tur, AB:
Fundacio Puigvert, Urol Dept, Barcelona, Spain
Somani, BK:
Univ Hosp Southampton NHS Fdn Trust, Southampton, England
hybrid, Green Published
|