Parallel Meeting on Thursday 18, June 2026, 14:00 - 15:00
14:00 - 14:03
S18-1 (CP)
Sherjeel SAULAT, Jahanzaib SHAIKH, Duramin N/A, Umber RASHEED and Ashba MUSHTAQUE
Tabba Kidney Institute, Urology, Karachi, PAKISTAN
PURPOSE
The aim is to assess the safety and efficiency of retrograde intra-renal surgery along with factors affecting the stone-free rates in pediatric population.
MATERIAL AND METHODS
This is a retrospective cross-sectional study, data was analyzed from 2019-2025 including children of age ≤ 15 years diagnosed with renal stones and advised for RIRS. They underwent RIRS with a 6 Fr tip-flexible scope with Ureteral Access Sheath of 9/11 Fr, and 272 micron Holmium laser was used to clear stones.
Complete pre-op, intra-op and post-op procedural details were analyzed and follow-up radiological investigations were evaluated. Patients with no residual stones were considered stone free. SPSS-23 was used to analyze the data.
RESULTS
A total sample size of 250 patients was included. 78% (n=195) of the patients were male while 22% (n= 55) were female with a mean age of 5.5 ± 4.3 years. Mean stone size of 6.2 ± 3.4 mm noted in right kidney while 3.5 ± 3.0 mm in left kidney.
44% (n= 110) patients were in the age group of 1 - 5 years, 14% (n=35) were infants less than 1 year of age, while 42% (n= 105) were above 5 years.
14% patients had cleared their stones in first seating while rest (86%) needed pre-stenting. Mean operative time was 47.1 ± 11.4 minutes and lithotripsy activation time was 22.1 ± 8.6 minutes. All of the patients less than 1 year of age underwent sheath-less RIRS with complete clearance.
Mean hospital stay was 1.0 ± 0.5 days. No significant blood loss was noted. Renal stone clearance rate was 94.4% on follow up and none of the patient needed redo surgery.
Comparative analysis was performed for safety and efficacy of the procedure between age groups and in terms of both post-operative and per-operative outcomes the p-value between groups was more than 0.05 (non-significant)
CONCLUSIONS
RIRS is a minimally invasive intervention with low morbidity in the treatment of childhood stone disease. It is as safe as it is in adults and it can efficiently clear renal stones provided that greater surgical expertise is involved.
14:03 - 14:06
S18-2 (CP)
Yesica QUIROZ MADARRIAGA 1, Carlotta NEDBAL 2, Deepak RAGOORI 3, Steffi YUEN 4, Chandra Mohan VADDI 5, Soundarya GANESAN 5, Olivier TRAXER 6, Daniele CASTELLANI 7, Bhaskar Kumar SOMANI 8, Vineet GAUHAR 9, Ea Jean LIM 9, Numan BAYDILLI 10, Halil TOSUN 10, Deniz DEMIRCI 10 and Anna BUJONS 1
1) Fundacio Puigvert, Paediatric Urology, Barcelona, SPAIN - 2) IRCCS San Gerardo di Monza, Urology, Monza, ITALY - 3) Asian Institute of Nephrology and Urology, Telangana, INDIA - 4) North District Hospital, Hong Kong, HONG KONG - 5) Preeti Urology and Kidney Hospital, Telangana, INDIA - 6) Hôpital Tenon, Paris, FRANCE - 7) Azienda ospedaliero-universitaria Ospedali riuniti di Ancona, Ancona, ITALY - 8) Hospital Southampton NHS Foundation Trust, Southampton, UNITED KINGDOM - 9) Ng Teng Fong General Hospital, Singapore, SINGAPORE - 10) Erciyes University Medical Faculty, Kayseri, TÜRKIYE
PURPOSE
Flexible ureteroscopy (fURSL) has become a standard approach for paediatric urolithiasis, though miniaturisation and access remainchallenging. Flexible Access and Navigation Sheath (FANS) has been introduced to facilitate access and irrigation in small ureters.We aimed to evaluate perioperative outcomes of FANS compared with the standard ureteral access sheath (UAS) in paediatricfURSL within a multicentre cohort
MATERIAL AND METHODS
A retrospective analysis was performed on 458 paediatric patients who underwent fURSL for urolithiasis between 2015 and 2025across 4 tertiary referral centres. Demographic, radiological, intraoperative, and postoperative parameters were collected. Patientswere divided into two cohorts according to access technique: UAS or FANS. The primary outcome was stone-free rate (SFR),defined as absence of residual fragments on postoperative ultrasonography. Secondary outcomes included intraoperative andpostoperative complications, hospital stay, and postoperative stent insertion. Statistical analyses were performed using the Mann–Whitney U, Student's t, and Chi-square/Fisher's exact tests. Significance was set at p<0.05
RESULTS
Of 458 patients, 424 were treated with UAS and 34 with FANS. Demographics were similar (female ratio 48.3% vs 50.0%, p=0.849),though FANS patients were older (12.3 ± 2.9 vs 8.9 ± 5.1 years, p<0.001) and had larger stones (12.3 ± 2.9 mm vs 10.0 ± 3.0 mm,p<0.001). Multiple stones were more common with FANS (81.3% vs 48.9%, p<0.001), and no patients were pre-stented (0% vs55.6%, p<0.001).
FANS use was associated with shorter operative time (26.7 ± 9.3 vs 63.8 ± 29.0 min, p<0.001) and lower postoperative stent rates(31.7% vs 68.3%, p<0.001), despite higher intraoperative mucosal injury Traxer grade I-II (84.4% vs 22.5%, p<0.001). Postoperativecomplications (6.3% vs 14.9%, p=0.175) and hospital stay (1.38 ± 0.48 vs 1.39 ± 0.80 days, p=0.891) were comparable. The SFRtended to be higher with FANS (60.0% vs 29.0%
CONCLUSIONS
FANS in paediatric fURSL was associated with significantly shorter operative time and reduced postoperative stenting, withcomparable safety and stone-free outcomes. Despite its use in older patients with larger and multiple stones, FANS appears to offeran effective alternative to standard UAS. Further prospective evaluation is warranted to confirm its role in optimising outcomes inpaediatric ureteroscopy.
14:06 - 14:09
S18-3 (CP)
Mevlut KELEŞ 1, Yesica QUIROZ MADARRIAGA 2, Numan BAYDILLI 3, Vineet GAUHAR 4, Halil TOSUN 5, Deniz DEMIRCI 3, Rocío JIMÉNEZ CORRO 6, Juan OSORIO IRIARTE 6, Carlotta NEDBAL 7, Deepak RAGOORI 8, Steffi YUEN 9, Chandra MOHAN VADDI 10, Soundarya GANESAN 10, Olivier TRAXER 11, Daniele CASTELLANI 12, Bhaskar KUMAR SOMANI 13 and Anna BUJONS TUR 6
1) Ordu University Faculty of Medicine, Urology, Ordu, TÜRKIYE - 2) FUNDACIÓ PUIGVERT,, UROLOGY, Barcelona, SPAIN - 3) Erciyes University Medical Faculty, Pediatric Urology, Kayseri, TÜRKIYE - 4) L Ng Teng Fong General Hospital, Urology, Singapore, SINGAPORE - 5) Erciyes University Medical Faculty,, Pediatric Urology, Kayseri, TÜRKIYE - 6) Fundació Puigvert, Urology, Barcelona, SPAIN - 7) Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria delle Marche, Urology, Ancona, ITALY - 8) Asian Institute of Nephrology and Urology, Urology, Telangana, INDIA - 9) Chinese University of Hong Kong (CUHK), Urology, Sheung Shui, HONG KONG - 10) Preeti Urology and Kidney Hospital, Urology, Telangana, INDIA - 11) Sorbonne University, Urology, Paris, FRANCE - 12) Università Politecnica delle Marche, Urology, Ancona, ITALY - 13) Southampton General Hospital, Urology, Southampton, UNITED KINGDOM
PURPOSE
Retrograde intrarenal surgery (RIRS) play a key role in paediatric kidney stone treatment. Different laser types became popular in this manner by years; especially Ho:YAG lasers for long years and recently, thulium fiber lasers (TFL) . In this study, we aimed to compare the effectivenes and safety of TFL and Ho:YAG laser on paediatric stone treatment with RIRS.
MATERIAL AND METHODS
Retrospective data of pediatric patients treated with RIRS across multiple tertiary centers worldwide were collected. Demographic data, surgical parameters, laser characteristics, stent placement, ureteral access sheath use, and stone-free outcomes were compared between two cohorts treated with either Ho:YAG or TFL lasers. Statistical analyses were performed with SPSS v30. Quantitative variables were evaluated using nonparametric tests, and categorical variables with chi-square or Fisher’s exact tests. Multivariable logistic regression was applied to identify independent predictors of stone-free rate (SFR).
RESULTS
A total of 548 pediatric RIRS procedures were analyzed (195 Ho:YAG, 353 TFL). Median age and baseline characteristics were comparable between groups. Stones treated with Ho:YAG were significantly larger, more often multiple, and more frequently located in the lower calyx (all p<0.05). Operative and laser times were shorter with TFL (p<0.001), and total energy use was markedly lower. Postoperative complications did not differ significantly, but reinterventions were fewer and hospital stay shorter with TFL (p<0.001). Multivariate analysis showed Ho:YAG associated with higher adjusted odds of being stone-free (OR = 2.05, p = 0.031), likely reflecting higher case complexity. Results are summerized in table 1.
Table 1: Effect of Laser Type on Stone-Free Rate After Adjustment for Confounding Factors using Multiple Binary Logistic Regression Analysis
|
|
β |
Standard error |
Wald |
p |
Odds Ratio |
95% Confidence Interval for Odds Ratio |
|
|
Lower Limit |
Upper Limit |
||||||
|
Lazer type |
|
|
|
|
|
|
|
|
TFL |
Reference |
|
|
|
|
|
|
|
HOYAG |
0,719 |
0,333 |
4,649 |
0,031 |
2,052 |
1,068 |
3,946 |
|
Confounding Factors Held Constant in the Model: Laser, larger stone size, operative time, ureteroscope fr, fıber laser, up, single_multiple, basket, lc, prestent |
|||||||
CONCLUSIONS
Both TFL and Ho:YAG lasers achieved high and comparable SFR in pediatric RIRS. TFL demonstrated superior surgical efficiency with shorter operative and laser times, lower energy consumption, and fewer reinterventions. However, Ho:YAG remained more effective in managing the most complex cases—larger, multiple, and lower-pole stones—achieving similar SFR despite higher case difficulty.
14:21 - 14:24
S18-4 (CP)
Jasim ALMAYALI 1, Hader ALGHANIMI 2 and Mohamed ALMEEDI 2
1) UNIVERSITY OF KUFA/ MEDICAL COLLEGE, Urology, Najaf, IRAQ - 2) ALDEWANIA HOSPITAL, Urology, Dewania, IRAQ
PURPOSE
we assess the safety and efficacy of mini-percutaneous nephrolithotomy under complete ultrasound guidance to treat renal stones in children.
MATERIAL AND METHODS
Prospective study includes 106 patients with renal stones treated by percutaneous nephrolithotomy (PCNL) under complete ultrasound guidance from March 2021 to April 2025. All patients included in this study underwent low-dose non-contrast computed tomography (NCCT). The procedure was performed under general anesthesia, the patient was placed in the lateral position with appropriate padding placed. Using ultrasonography, an 18-gauge needle was inserted into the targeted calyx. After urine reflux observation, a guidewire was inserted through the needle into the collection system and the guidewire position was determined by ultrasound. A 1-cm incision was made and dilated using 12 Fr fascial dilators over the guidewire and then using Alkins metallic dilator up to 22 fr. Stone fragmentation was achieved with a pneumatic lithotripter. At the end of the operation ultrasonographic visualizations was used to assess whether the patients were stone-free. double-J stent for 1–4 weeks.
All patients were assessed one day and one month and three months after surgery by ultrasound. Operative time, stone free rate and any complications were recorded.
RESULTS
A total of 106 patients (64boys,42 girls) were included in our study. Patients age range 2 to 14 years (mean 5.6 years). Stone size 12 to 42 mm (mean 18 mm).
14 patients (13.2%) had bilateral renal stones. The operation time was 22-85 min (mean 38 min).
The stone free rate was 88.6% (94/106). The most common complication was postoperative fever, which was observed in 12 (11.2%) children. 5 (4.7%) children had significant hematuria and required blood transfusion. 3 (2.8%) child developed minor pelvic perforations and treated by double-J stent for 4 weeks.
CONCLUSIONS
Ultrasound-guided PCNL is safe and effective,avoiding radiation exposure and lower risk of organ injury.
14:24 - 14:27
S18-5 (CP)
Pushpaketu NALUBOLU 1 and Nalubolu MALLIKARJUNA REDDY 2
1) Hind Medical College, Urology, Lucknow, INDIA - 2) Yashoda Hospital, Urology, Hyderabad, INDIA
PURPOSE
Standard-tract PCNL (SPCNL) and mini-tract PCNL (MPCNL) are safe and efficacious minimal invasive approaches for the treatment of renal stones. Intra renal pelvic pressure, which is remarkably increased during the operation of PCNL, is closely related to the irrigation pressure. Systemic absorption of irrigation fluid, which may contain bacteria or endotoxins caused by high renal pelvic pressure (RPP), may lead to postoperative fever. This study is to analyze whether MPCNL is associated with both higher RPP and incidence of postoperative fever when compared with SPCNL in real time.
MATERIAL AND METHODS
This study included 102 children which were randomly allocated to SPCNL[66] and MPCNL[36] arms. SPCNLs were performed with 24Fr amplatz sheath and 18.5Fr of nephroscope. MPCNLs were performed with 15Fr amplatz sheath and 12Fr nephroscope.The 4Fr/70cm ureteric catheter with its tip placed in renal pelvis was connected to Urodynamic Analyzer. RPP of patients in both arms were measured and were divided into two groups i.e RPP ≥ 40cm of H2O and RPP < 40cm of H2O. Accumulated times RPP ≥ 40cm of H2O were measured and were divided in to two arms i.e ≥ 60sec and < 60sec. Relation between RPP and postoperative fever between MPCNL and SPCNL group were compared and analyzed. Statistical analysis was performed by SPSS. Preopeative urine cultures were negative before surgery.
RESULTS
Mean Maximum RPP [cm of water] are 67.14±14.77 and 35.38±8.65 in MPCNL and SPCNL respectively. Mean average RPP [cm of water] are 30.50±5.08 and 17.61±3.54 in MPCNL and SPCNL respectively. The incidence of Fever [≥38.5F] in group with maximum RPP ≥40cm of H2O are 9[25%] and 6[9%] in MPCNL and SPCNL respectively. The incidence of Fever [≥38.5F] in group with maximum RPP <40cm of H2O are 2[5.55%] and 1[1.5%] in MPCNL and SPCNL respectively. The incidence of Fever [≥38.5F] in group with maximum RPP ≥40cm of H2O are 9[25%] and 6[9%] in MPCNL and SPCNL respectively. Among the patients with maximum RPP ≥40cm of H2O, accumulated time that was longer than 60 seconds appeared as a risk factor for the development of postoperative fever.
CONCLUSIONS
This study supports the notion that MPCNL was associated with higher RPP and an increased incidence of postoperative fever in comparison to SPCNL when the accumulated time was more than 60 seconds.
14:27 - 14:30
S18-6 (CP)
Ahmad ELDERWY 1, Rabea GADELKAREEM 2, Ahmed ELTAHER 2, Ahmad SHAHAT 1, Mostafa KAMEL 2 and Mohamed ELGENDY 2
1) Faculty of Medicine, Assiut University, Pediatric Urology, Assiut, EGYPT - 2) Faculty of Medicine, Assiut University, Urology, Assiut, EGYPT
PURPOSE
Percutaneous nephrolithotripsy (PCNL) is the standard treatment for large renal stones. The flank-free modified supine position (FFMSP) of PCNL was proposed to overcome limitations of both prone and conventional supine posture and to improve ergonomics and anesthetic safety. This trial compared the efficacy and safety of FFMSP versus prone PCNL in pediatric patients.
MATERIAL AND METHODS
A total of 100 pediatric patients (≤18 years) with renal stones (Guy’s score I–II) were randomized into two equal groups: Group A underwent PCNL in FFMSP, and Group B in the prone position. Demographic, operative, and postoperative parameters were compared, including operative time, airway pressure (Pmax), intrarenal pelvic pressure, stone-free rate, and complications graded by the modified Clavien–Dindo classification.
RESULTS
Baseline demographic and stone characteristics were comparable between groups. The mean operative time was significantly shorter in the supine group (43.7 ± 18.7 min) than in the prone group (54.1 ± 24.4 min, p = 0.021). Peak airway pressure after positioning was lower in the supine group (16.7 ± 1.7 cm H₂O) compared to prone (18.0 ± 3.3 cm H₂O, p = 0.006). Mean pelvic pressure, fluoroscopy time, hospital stay, and postoperative hemoglobin drop did not differ significantly. The stone-free rate was 90% in the supine group and 80% in the prone group (p = 0.161). Complication rates were similar (12% vs. 16%, p > 0.05), and no major (≥Grade IIIb) complications occurred.
CONCLUSIONS
In children with Guy’s score I–II renal stones; the flank-free modified supine PCNL provides comparable stone clearance and safety outcomes to the prone PCNL, with shorter operative time and lower airway pressure.
14:42 - 14:45
S18-7 (CP)
Ossama MAHMOUD, Mahmoud ABDALLAH, Ahmed ABDELLATIF, Ahmed Hamdy MOSTAFA, Anas ALBUDAIRAT, Akram ALMARAKBY and Hany F. BADAWY
Faculty of medicine BeniSuef University, Urology, Benisuef, EGYPT
PURPOSE
Pediatric renal stones.
MATERIAL AND METHODS
A prospective randomized clinical study included 70 children aged 3-14 years presenting with solitary renal pelvic stones1000 HU on non-contrast CT. Patients with prior renal surgery, active urinary infection, distal obstruction, congenital anomalies, coagulopathy, or renal insufficiency were excluded. Eligible patients were randomly assigned into two equal groups (n=35) to undergo either retrograde intrarenal surgery (RIRS) or mini-percutaneous nephrolithotomy (mini-PCNL).
Outcomes assessed included stone-free rate at one month (low-dose NCCT), operative time, hospital stay, catheter duration, radiation exposure, hemoglobin drop, and postoperative complications classified according to the modified Clavien-Dindo system.
RESULTS
At one month, the stone-free rate was 94.3% in the mini-PCNL group and 91.4% in the RIRS group, with no significant difference (p=0.643). RIRS demonstrated significantly shorter operative time (72.7 vs 80.5 minutes), hospital stay (1.1 vs 1.3 days), catheter duration (1.2 vs 2.1 days), and radiation exposure (34.6 vs 115.1 seconds) (all p<0.05). Hemoglobin drop was minimal with RIRS (0.01 g/dL, p=0.097), whereas mini-PCNL showed a significant decrease (0.74 g/dL, p<0.001).
Postoperative complications occurred in 4 patients (11.4%) following RIRS and in 6 patients (17.1%) following mini-PCNL, predominantly minor (Grade I-II), with no significant difference between the two groups (p=0.47).
CONCLUSIONS
Both RIRS and mini-PCNL are safe and effective options for managing pediatric renal stones.
14:45 - 14:48
S18-8 (CP)
Javidan BAGHIROV 1, Aysegül AKBULUT 2, Mehmet Uğur YILMAZ 3, Tuğçe Merve ORBAY 4, Merve DEDE 4, Mehmet Emin BALKAN 4 and Nizamettin KILIÇ 4
1) Uludag University Faculty of Medicine, Pediatric Surgery, Bursa, TÜRKIYE - 2) Uludag University Faculty of Medicine, Pediatric surgery /Division of Pediatric Urology, Bursa, TÜRKIYE - 3) Bursa Uludag University Faculty of Medicine, Pediatric Surgery /Division of Pediatric Urology, Bursa, TÜRKIYE - 4) Bursa Uludag University Faculty of Medicine, Department of Pediatric Surgery Division of Pediatric Urology, Bursa, TÜRKIYE
PURPOSE
This study aimed to compare the efficacy and safety of retrograde intrarenal surgery (RIRS) and ultra-mini percutaneous nephrolithotomy (UMP) in treating renal stones smaller than 2 cm in pediatric patients.
MATERIAL AND METHODS
We retrospectively reviewed 104 pediatric patients who underwent surgery for renal stones <2 cm between January 2017 and December 2024. Patients were grouped based on surgical technique: RIRS (n=56) and UMP (n=48). Groups were compared in terms of age, gender, symptoms, stone size and location, degree of hydronephrosis, operative time, fluoroscopy time, 1-month stone-free rate (SFR), hospital stay, drainage method, additional interventions, final SFR, and complications.
RESULTS
The 1-month SFR was 75% for RIRS and 83.3% for UMP (p>0.300). Mean operative time was shorter in the RIRS group (70 vs. 90 minutes, p<0.05), and fluoroscopy time was significantly lower (24 vs. 114 seconds, p<0.001). Hospital stay was also shorter after RIRS (2 vs. 4 days, p<0.001). Both groups experienced only low-grade complications (Clavien 1-2), with no significant difference in complication rates (p=0.507). UMP showed higher efficacy in lower pole stones and hard stones, such as cystine or calcium phosphate.
CONCLUSIONS
Both RIRS and UMP are safe and effective for pediatric renal stones <2 cm. RIRS offers shorter operative time, lower radiation exposure, and reduced hospitalization, while UMP may achieve higher success rates, particularly in lower pole or hard stones. For lower pole stones <2 cm, UMP appears superior to RIRS. To our knowledge, this is the first study comparing UMP and RIRS in the pediatric population.