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LETTER TO EDITOR
Year : 2021  |  Volume : 37  |  Issue : 2  |  Page : 201-202
 

Re: Chandramohan V, Siddalingaswamy PM, Ramakrishna P, Soundarya G, Manas B, Hemnath A. Retrograde Intrarenal Surgery for renal stones in children <5 years of age. Indian J Urol 2021;37:48-53


Department of Urology, AIIMS, Bhubaneshwar, Odisha, India

Date of Submission04-Jan-2021
Date of Acceptance07-Mar-2021
Date of Web Publication1-Apr-2021

Correspondence Address:
Swarnendu Mandal
Department of Urology, AIIMS, Bhubaneshwar, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.IJU_6_21

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How to cite this article:
Tripathy S, Mandal S, Das MK, Nayak P. Re: Chandramohan V, Siddalingaswamy PM, Ramakrishna P, Soundarya G, Manas B, Hemnath A. Retrograde Intrarenal Surgery for renal stones in children <5 years of age. Indian J Urol 2021;37:48-53. Indian J Urol 2021;37:201-2

How to cite this URL:
Tripathy S, Mandal S, Das MK, Nayak P. Re: Chandramohan V, Siddalingaswamy PM, Ramakrishna P, Soundarya G, Manas B, Hemnath A. Retrograde Intrarenal Surgery for renal stones in children <5 years of age. Indian J Urol 2021;37:48-53. Indian J Urol [serial online] 2021 [cited 2021 Apr 20];37:201-2. Available from: https://www.indianjurol.com/text.asp?2021/37/2/201/312932


We read the article by Chandramohan et al.[1] titled “Retrograde intrarenal surgery for renal stones in children <5 years of age” with interest. We appreciate the authors for providing insight towards the feasibility and complication rates of RIRS in preschool children. However, we would like to highlight a few points for consideration.

During initial work up, intravenous pyelogram or computed tomography (CT) scans were performed for stone size estimation. Similar tests could have been done to assess the stone free rate (SFR) in the postoperative period also but the authors used X-ray kidney, ureteric, and bladder (KUB) for radiopaque stones and noncontrast CT (NCCT) KUB for radiolucent stones. A low dose NCCT KUB would have been a better option for all cases as it is the gold standard. The authors also did not mention the implication of DTPA scan in the overall outcome; did the poorly functioning kidneys have lower SFR? Also was urine culture done before stenting as well as RIRS or just before RIRS?

It has been mentioned that flexible or rigid ureteroscopy was routinely done to look for any ureteral injury, then why was retrograde pyelography (RGP) done in each case? It could have been done only in suspected cases of injury. Is there any recommendation to do RGP in all cases postoperatively or is it just an institutional practice?

Postoperative fever more than 38°C was observed in eight cases in the present study and all were managed conservatively as per the author. However, in the methodology section, the authors have mentioned “Children with temperature more than 38°C, elevated total leukocyte counts, and elevated C-reactive protein levels were treated with higher antibiotics as per the hospital antibiogram.” Were they not given any antibiotics apart from single-dose prophylactic Cefotaxime? If this was done, the grading of complication would be grade II and not I.

In the follow-up, ultrasound was performed at the end of 2 months which revealed stones ≤2 mm in 45 children, providing a SFR of 76.3%. Whereas in [Table 2] of the original manuscript it is mentioned that residual stone >2 mm was found in 9 children (15.3%), what happened to the other 4 children (out of the 59 children analyzed)?

The authors have mentioned that they included 62 patients initially, out of whom 5 had bilateral calculi making the total renal units 67. Whereas in [Table 1] of the original manuscript, where they have mentioned side of stones, there seems to be some discrepancy of data as right (n = 24) and left (n = 38) added should be 57 renal units (plus 10 for 5 bilateral cases) on the contrary to 62 (24 + 38 = 62) as mentioned.

The authors mention in the discussion that the study done by Ekurt et al.[2] “had reported overall complication of 27.7% but they did not use Clavien system”; however, in the quoted paper, the authors actually state that “Complications were observed in 18 (27.7%) patients and classified according to Clavien system”.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

 
   References Top

1.
Chandramohan V, Siddalingaswamy PM, Ramakrishna P, Soundarya G, Manas B, Hemnath A. Retrograde intrarenal surgery for renal stones in children 5 years of age. Indian J Urol 2021;37:48-53.  Back to cited text no. 1
  [Full text]  
2.
Erkurt B, Caskurlu T, Atis G, Gurbuz C, Arikan O, Pelit ES, et al. Treatment of renal stones with flexible ureteroscopy in preschool age children. Urolithiasis 2014;42:241-5.  Back to cited text no. 2
    




 

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