Comparison of Pediatric Retrograde Intrarenal Surgery Outcomes in Less than 2 cm Single Stones: Lower Pole and Other Localizations

Objective: Our study aimed to investigate the effect of lower pole localization in solitary stones smaller than 2 cm on pediatric retrograde intrarenal surgery (RIRS) outcomes compared to other localizations.
Materials and Methods: Data from patients who underwent RIRS in a university hospital between January 2021 and June 2024 were retrospectively analyzed. The study included 69 patients under 18 years of age with single stones less than 2 cm and whose data were available. Patients were divided into two groups according to kidney stone localization: lower pole (Group 1) and other localizations (Group 2). Demographic data, clinical characteristics, stone-related data, and perioperative and postoperative data of the patients were statistically compared in both groups.
Results: The study enrolled 69 patients with a mean age of 7±4.4 (1-17) years and a mean stone size of 11±3.3 (5-20) mm. There were 21 patients in Group 1 and 48 patients in Group 2. The patient's demographic data and clinical characteristics in both groups were similar. The groups' stone size, side, and density were similar (p=0.58, 0.58, and 0.63, respectively). The prestenting rate was statistically significantly higher in Group 1 than in Group 2 (76.2% vs 50%, p=0.04). No statistically significant difference was detected between the groups in access sheath use, operation time, fluoroscopy time, the stone-free rate on 1st day and 3rd month, or auxiliary procedures (p=0.69, 0.95, 0.60, 0.97, 0.27, and 0.28, respectively). The complication rates were similar in both groups (p=0.28). No high-grade or anesthesiarelated complications were observed in any of the patients.
Conclusion: The lower pole localization does not affect surgical parameters, except for the prestenting rate, in single stones smaller than 2 cm. Considering that prestenting is performed under general anesthesia in the pediatric population, lower pole stones may increase the number of anesthesia sessions, radiation exposure, and hospitalizations.