Can cystinuria decrease the effectiveness of RIRS with high-power ho:yag laser in children? Outcomes from a tertiary endourology referral center

• Published in: Urolithiasis 2022-04, Vol.50 (2), p.229-234
• Main Authors: Quiroz Madarriaga, Yesica, Badenes Gallardo, Almudena, Llorens de Knecht, Erika, Motta Lang, Guilherme, Palou Redorta, Joan, Bujons Tur, Anna
• Format: Article
• Language: English
• Subjects: Catheters; Child; Cystinuria - surgery; Genetic counseling; Humans; Kidney Calculi - surgery; Kidney stones; Lasers; Lasers, Solid-State - therapeutic use; Lithotripsy; Medical Biochemistry; Medicine; Medicine & Public Health; Metabolic disorders; Nephrology; Original Paper; Patients; Pediatrics; Prospective Studies; Referral and Consultation; Surgery; Treatment Outcome; Urinary tract diseases; Urine; Urogenital system; Urology
• ISSN: 2194-7236; 2194-7228; 2194-7236
• DOI: 10.1007/s00240-022-01301-w

Cystinuria, which is the cause of cystine urolithiasis, accounts for 2–6% of all urinary stones in children, has a low prevalence with a high recurrence rate, making this metabolic disorder a therapeutic challenge in pediatric population. The aim of this work is evaluate the efficacy and safety of retrograde intra-renal surgery (RIRS) in pediatric patients with cystinuria and kidney stones smaller than 2 cm. Prospective study of 64 stones treated in 22 retrograde intra-renal surgeries (RIRS) in cystinuric pediatric patients with renal or proximal ureteral stones less than 2 cm. Average age of 9.5 years. The following data were analyzed: demographics, stone characteristics and surgical data with intra- and postoperative complications. Location of the stones was 68.7% in the calyces, 20.3% in the renal pelvis, and 9.3% in the ureteropelvic junction; 41% of cases had multiple locations. The average cystinuria level before the procedure was 825 mg/dL. The anatomy of 73% of the interventions increased the difficulty of flexible ureteroscopy and decreased stone free rates, because distorted renal anatomy was present: sclerosis of the pelvis or infundibulum, abnormal calyceal dilations, or excluded calyces. Intraoperative complications occurred in 18.2% of the procedures. Reno-vesical ultrasound was performed in all patients in the first postoperative month, with an SFR of 59%. Cystinuric patients are a challenge for pediatric urologists, decreasing the effectiveness of RIRS. However, it could be better treatment than SWL and with fewer complications than PCNL in the pediatric population with this disease.