Login to Access Video or Poster Abstract: MP68-08
Sources of Funding: None

Introduction

The use of retrograde intrarenal surgery (RIRS) in children for management of upper tract urinary stones is on the rise. This is best accomplished by flexible ureteroscopy and laser lithotripsy; however, this might not be feasible in centers of limited resources. We present our experience with RIRS using semirigid ureteroscopy with the help of positional maneuvers to facilitate success of RIRS

Methods

Fifty children underwent RIRS and laser lithotripsy with the aid of series of kidney position manipulations including: manually uplifting the kidney by flank elevation, pushing the kidney down by anterior abdominal wall pressure, rotating the kidney medially or laterally by manual pressure in the lateral flank or midline, placing the patient in Trendelenburg or reverse Trendelenburg position, altering respiratory rate and tidal volume and use of syringe pressurized irrigation or suction to alter stone position and help getting stone in the target zone of the ureteroscopy.

Results

Twenty seven children had a renal pelvic stone, 12 with upper calyceal stones, 7 with middle calyceal stones and 4 with lower calyceal stones. Forty two (84%) patients were rendered stone free with the help of positional manipulation described. No intraoperative complication except for mild extravasation in two cases. Mean operative time was 52 minutes. Five patients of febrile UTI and two cases of moderate hematuria successfully managed conservatively in postoperative period.

Conclusions

Positional manipulation for RIRS using semirigid ureteroscopy in children is a successful and cost effective approach with low complication rates. However, this approach might not be possible when ureteric or pelvicalyceal anatomy is unfavorable.

Funding

None