Retrograde intrarenal lithotripsy in completely bedridden children with severe physical disabilities

Pediatric urolithiasis is often associated with a metabolic disease or with a complication of steroid or antiepileptic agent use. Children who are on long-term bed rest or bedridden are also said to be at risk for urinary stone formation. Here we report two cases of compromised completely bedridden children with renal stones who achieved stone-free status without any complications through detailed intraoperative management. The patient in case 1 is an 8-year-old compromised bedridden boy with epilepsy, chromosomal abnormalities, and ulcerative colitis. In case 2, the patient is a 9-year-old compromised bedridden girl with hypoxic-ischemic encephalopathy and epilepsy. Both children had recurrent urinary tract infections (UTIs), and lithotripsy was planned for multiple renal stones. The patients were expected to be at high risk of developing a postoperative febrile UTI because they are compromised completely bedridden children. A 9.5/11.5-Fr ureteral access sheath was inserted, and lithotripsy was performed. The irrigation flow rate during lithotripsy was frequently adjusted and aspiration of intrarenal saline as necessary so as not to increase intrarenal pressure, with the aim of preventing postoperative febrile UTI. Stone-free status was achieved in both cases, without any intra and postoperative complications.