SynthesisWorld journal of urology2025
Role of pediatric ureteroscopy for large renal stones: a systematic review and meta-analysis from EAU endourology.
Synthesis in World journal of urology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
purposeTo 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.
methodsA 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.
resultsEight 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.
conclusionsRIRS 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.
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