Single-use, low-profile flexible ureterorenoscopy in paediatric lithiasis: Preliminary experience expanding the boundaries of ESPU recommendations.

INTRODUCTION

Single-use flexible ureterorenoscopy (fURS) is a well-established practice today in adult patients with urological lithiasis. Its application in children is becoming more widespread thanks to the availability of lower profile devices (<7Fr). Its indication remains limited in ESPU clinical guidelines. The aim of this study is to present our clinical experience and analyse the applicability of these guidelines in our practice.

METHODS

A retrospective observational descriptive study was designed. Patients who underwent laser lithotripsy with single-use ureterorenoscopes during 2023-2024 were included.

RESULTS

Eleven paediatric patients who underwent a total of 15 procedures were included. The mean age was 9.48 years (range: 2-16). The median stone size was 9 mm (range: 5-27). Six (40%) were located in the lower calyx. Up to 6 patients (40%) had multiple lithiasis and 3 of them (20%) had coraliform lithiasis. The most common composition was calcium oxalate in 7 cases (46.67%), followed by cystine in 5 (33.33%). Most were treated by Holmium laser lithotripsy assisted with 7.5 Fr ureterorenoscopes on a 10-12 Fr ureteral sheath. The mean hospital stay was 1.20 days (SD ± 0.56). The procedure was successful in 11 patients (73.33%). Four of them (26.67%) underwent reoperation due to the presence of residual stones larger than 5 mm on ultrasound. Complications were reported in 2 patients (13.33%), Clavien-Dindo categories I and III.

CONCLUSION

Single-use fURS is an effective and safe alternative for the treatment of urological lithiasis in children. It has good results in terms of safety, recovery time, and stone removal, even in coral-shaped or lower calyx stones. These preliminary results suggest that single-use fURS may support an expansion of current ESPU indications, though larger prospective studies are needed to confirm these findings.