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Purpose <p>To evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) for treating renal stones ≥ 1&#xa0;cm in pediatric patients, and to assess its potential as a stand-alone alternative to percutaneous interventions.</p> Methods <p>A systematic review and meta-analysis were conducted in accordance with a pre-registered PROSPERO protocol (CRD420251073155). A comprehensive literature search identified studies published in the last five years reporting outcomes of RIRS for renal stones ≥ 1&#xa0;cm in patients under 18 years. Data were extracted on demographics, procedural characteristics, stone-free rate (SFR), complications, and auxiliary procedures. Meta-analysis of proportions using a random-effects model was performed. Heterogeneity was explored via meta-regression and sensitivity analyses.</p> Results <p>Eight studies (two RCTs, four non-randomized comparative studies, and two single-arm cohorts) encompassing 361 patients were included. The pooled initial SFR was 79% (95% CI: 68–87%) with high heterogeneity (I² = 74.2%). Meta-regression identified stone multiplicity and lower pole location as significant contributors to heterogeneity, explaining 100% of between-study variance. The pooled auxiliary procedure rate was 20% (95% CI: 10–30%) and significantly influenced by the SFR cut-off used. Clavien-Dindo grade I–II complications occurred in 10% of cases (95% CI: 0–20%), while there were no ≥ grade III complications. The pooled operative time was 77.3&#xa0;min, fluoroscopy time 71.6&#xa0;s, and length of stay 1.6 days.</p> Conclusions <p>RIRS is a feasible and generally safe option for managing large renal stones in children. However, variable definitions, heterogeneous populations, and limited high-quality evidence underscore the need for caution in interpretation. Future prospective, well-powered studies are warranted to better define RIRS outcomes and its role in contemporary pediatric stone management.</p>

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Role of pediatric ureteroscopy for large renal stones: a systematic review and meta-analysis from EAU endourology

  • 期刊论文

  • 发表日期：

    2025年11月2日

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  • Ali Talyshinskii,
  • Gafour Khairley,
  • Anna Bujons Tur,
  • Vineet Gauhar,
  • Andreas Skolarikos,
  • Azimdjon Tursunkulov,
  • Eugenio Ventimiglia,
  • Laurian Dragos,
  • Vincent De Coninck,
  • Bhaskar Kumar Somani

摘要

Purpose

To evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) for treating renal stones ≥ 1 cm in pediatric patients, and to assess its potential as a stand-alone alternative to percutaneous interventions.

Methods

A systematic review and meta-analysis were conducted in accordance with a pre-registered PROSPERO protocol (CRD420251073155). A comprehensive literature search identified studies published in the last five years reporting outcomes of RIRS for renal stones ≥ 1 cm in patients under 18 years. Data were extracted on demographics, procedural characteristics, stone-free rate (SFR), complications, and auxiliary procedures. Meta-analysis of proportions using a random-effects model was performed. Heterogeneity was explored via meta-regression and sensitivity analyses.

Results

Eight studies (two RCTs, four non-randomized comparative studies, and two single-arm cohorts) encompassing 361 patients were included. The pooled initial SFR was 79% (95% CI: 68–87%) with high heterogeneity (I² = 74.2%). Meta-regression identified stone multiplicity and lower pole location as significant contributors to heterogeneity, explaining 100% of between-study variance. The pooled auxiliary procedure rate was 20% (95% CI: 10–30%) and significantly influenced by the SFR cut-off used. Clavien-Dindo grade I–II complications occurred in 10% of cases (95% CI: 0–20%), while there were no ≥ grade III complications. The pooled operative time was 77.3 min, fluoroscopy time 71.6 s, and length of stay 1.6 days.

Conclusions

RIRS is a feasible and generally safe option for managing large renal stones in children. However, variable definitions, heterogeneous populations, and limited high-quality evidence underscore the need for caution in interpretation. Future prospective, well-powered studies are warranted to better define RIRS outcomes and its role in contemporary pediatric stone management.