The effect of prestenting on the success rates of endourological stone surgery in children.

PURPOSE: Endoscopic treatment of urinary tract stones in children can be technically demanding. Preoperative ureteral stenting (prestenting) has been proposed to facilitate access and improve outcomes, yet its impact across different paediatric age groups remains unclear. This study evaluated the association between prestenting and first-session stone-free rate (SFR) in children undergoing ureterorenoscopy (URS) or retrograde intrarenal surgery (RIRS), and identified factors independently associated with prestenting.

METHODS

We retrospectively reviewed 126 children treated with URS or RIRS for urolithiasis between 2017 and 2025, grouped as < 2 years, 2-5 years, and 5-18 years. First-session SFRs were compared between prestented and non-prestented patients. Multivariate logistic regression was used to identify independent predictors of prestenting.

RESULTS

Prestenting rates were highest in children < 2 years (72.0%), followed by 2-5 years (41.7%) and 5-18 years (18.2%) (p < 0.001). Among children < 2 years, prestenting significantly improved first-session SFR (100.0% vs. 42.9%, p = 0.003). No such benefit was seen in the 2-5 years (90.0% vs. 92.4%, p = 1.000) or 5-18 years groups (78.6% vs. 82.0%, p = 0.71); overall differences were not significant (90.5% vs. 82.7%, p = 0.199). In multivariate analysis, age < 2 years (OR 23.9, p < 0.001), age 2-5 years (OR 4.8, p = 0.021), and previous stone surgery (OR 7.9, p < 0.001) were independently associated with prestenting.

CONCLUSION

Prestenting was associated with a higher first-session SFR in children younger than 2 years but not in older age groups, supporting a selective, age-sensitive approach to prestenting.