V02-09 RIRS IN INFANTS (<12 MONTHS); OUR TECHNIQUE AND RESULTS

Abstract

You have accessJournal of UrologyCME1 Apr 2023V02-09 RIRS IN INFANTS (<12 MONTHS); OUR TECHNIQUE AND RESULTS Chandra Mohan Vaddi, Ramakrihsna Paidakula, Siddalinga Swamy P. M., Soundarya Ganesan, Hemnath U. A., Manas Babu B., and Rakesh Panda Chandra Mohan VaddiChandra Mohan Vaddi More articles by this author , Ramakrihsna PaidakulaRamakrihsna Paidakula More articles by this author , Siddalinga Swamy P. M.Siddalinga Swamy P. M. More articles by this author , Soundarya GanesanSoundarya Ganesan More articles by this author , Hemnath U. A.Hemnath U. A. More articles by this author , Manas Babu B.Manas Babu B. More articles by this author , and Rakesh PandaRakesh Panda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003232.09AboutAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Abstract INTRODUCTION AND OBJECTIVE: Retrograde intrarenal surgery (RIRS) is an established procedure in adults. But there is paucity of literature on the feasibility and safety of RIRS in infantile age group (<12 months). It is less explored, because of the fear of injury to the small calibre urethra and ureter, and risk of sepsis in infants. In this video presentation we share our technique of doing RIRS safely in infants, and our experience and results. METHODS: In this video presentation we are showing the steps we follow to do RIRS safely in infants: Pre-stenting with 3.5 Fr/ 16 cm Double ‘J’ stent Positioning Meatal calibration Ureteroscopy with 6/7.5 Fr semirigid ureteroscope Passing 2 guidewires (safety guidewire – 0.018” and 0.035”) Manoeuvring upper ureteric kink (commonly seen in infants) with Mertz manoeuvre Backloading flexible ureteroscope over 0.035” guidewire (no access sheath used) Continuous bladder drainage with suprapubic aspiration in males and infant feeding tube in females. Initial retrograde pyelogram (RGP) Laser lithotripsy settings and technique Basketing small fragment for biochemical stone analysis RGP at the end Inspection of ureter for injuries Double ‘J’ stent (3.5 Fr/ 16 cm) placement RESULTS: See table. CONCLUSIONS: RIRS is a safe and feasible option for renal stone management in infants. It gives a good stone free rate comparable to other modalities. Even though incidence of post-operative fever is higher than in adults, there are no grade 3 & 4 complications encountered. Age in months (mean ± SD) 10 ± 2.31 (range, 4 – 12) Sex Male/ Female 15/8 Weight in kg (mean ± SD) 7.79 ± 1.25 (range, 4.5 – 9.5) Stone laterality Unilateral – 82.7% (Right – 10; Left – 9) Bilateral – 17.3% Multiplicity Single – 23 Multiple – 4 Stone size in mm (mean ± SD) 11.6 ± 2.96 (range, 7.5 - 19) Variables Mean ± SD RIRS time (min) 29.44 ± 7.45 (range, 17 – 42 mins) Laser time (min) 18.66 ± 5.2 (range, 8 – 29 mins) Irrigation fluid (ml) 331.4 ml (range 220 – 420 ml) Catheterisation (mean) (days) 1.47 (range, 1 – 6) Hospital stay (mean) 2.73 (range, 2 – 8) Stone free rate 85.1% Stone composition Mixed stones – 7 Calcium oxalate dihydrate – 7 Calcium oxalate monohydrate – 4 Uric acid – 3 Metabolic abnormality No abnormality – 15 Hypocitraturia – 4 Hypercalciuria – 3 Hyperuricosuria – 1 Complications FeverGrade 1 – 5 patients (21.7%) Grade 2 – 2 patients (8.6%)Hematuria Grade 1 – 6 patients (26%)Grade 3 & 4 – nil Source of Funding: Self © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e170 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chandra Mohan Vaddi More articles by this author Ramakrihsna Paidakula More articles by this author Siddalinga Swamy P. M. More articles by this author Soundarya Ganesan More articles by this author Hemnath U. A. More articles by this author Manas Babu B. More articles by this author Rakesh Panda More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...