Session: MP23: Stone Disease: Surgical Therapy (including ESWL) I
MP23-16: Pediatric retrograde intra renal surgery with Thulium fibre laser or High power Holmium laser. Is there a clear winner: Our experience in 126 cases
Introduction: Pediatric retrograde intra renal surgery(RIRS) is a well established treatment for renal calculus management. Unlike in adults the use of high power holmium lasers(HPL) and thulium fiber laser(TFL) has been restrained with no direct comparative studies showing pros and cons of using these in children . Our primary aim is to compare the safety, efficacy and outcomes of using these with respect to stone free rate (SFR) and complications in different age groups. Secondary aim is to see if there is a clear winner for RIRS. Methods: Retrospective data from 4 global centers on RIRS using either or both lasers in children collated for an anonymized registry after appropriate ethic board approvals .Only Children up to the age of 17 with normal pelvicalyceal system (PCS) anatomy, calculi in any location who underwent RIRS as per institutes own protocols with HPL(>60 watt) or TFL were included. SFR at 3-month deemed as a single residual fragment (RF) =2 mm/absence of multiple fragments. Patients divided into two groups (Gr 1 HPL vs Gr 2 TFL). Student’s, Chi-square and Fisher’s exact test used to assess differences. Univariable (UV) and multivariable(MV) logistic regression analysis to predict RF. Statistical significance was p-value <0.05. Results: 126 children,29 in group2 and 97 in group1 which had older children (10 years vs 7.05, P=0.004). 79.3% children in group 2 were boys(p=0.047)vs 56.7% in group 1.Loin pain was main indication for surgery (Gr2 80%vs 45.25%, p=0.005).pre-stented was more in group 2(69%vs 50.5%). Mean stone diameters were comparable (9.70mm Gr1 vs 10.91 Gr2 ). Multiples stones were more in group 2( 51.7% vs 30.9%). Fairly similar renal distribution of stones. UAS use was significantly higher in GR2 (70.45 vs 30.1%; p=0.001). Dusting and popcorning was equally used in both. None of the patients in Group2 needed post op stenting (23.3% in Gr1). No differences in Laser and operative time. Postop fever and transient hematuria noted in the same 5 patients in Gr1 only. No sepsis in either group. While not significant SFR was higher in Gr 2 (89.7 vs 81.4%; p=0.449). 15 children in Gr 1 vs 2 in Gr2 had relook RIRS fro RF within 3 months of rst procedure. Significantly higher SFR seen in children with presenting (p=0.011) and single stones(p=0.008) in UV analysis. Conclusions: Our unique study clearly shows that both lasers are equally effective and safe in children of any age group for any stone location using popcorning and or dusting technique. TFL had a slight advantage with higher single stage SFR, lesser Rf reintervention. Pre-stenting when suitable can help improve SFR. Children with multiple stones may need a relook RIRS. Post operative stenting was very low in our cohort. Further studies must investigate if using these lasers does indeed omit this after RIRS in children. SOURCE OF Funding: NIL
