INTRODUCTION AND OBJECTIVE: Minimally invasive, outpatient procedures remain in vogue in the field of urology for both cost savings and patient satisfaction. The adoption of mini percutaneous nephrolithotomy (PCNL) from pediatric cases in the adult population allows the patient to undergo lithotripsy of larger stone burden with a smaller caliber sheath. Reduced bleeding, improved visibility, and shortened hospital stay are a few suggested benefits of this approach. In this study, we have attempted to quantify the potential cost savings in our experience utilizing mini PCNL in patients with stones >1.5 compared to traditional PCNL.METHODS: A retrospective review was performed over the period June 2016 to August 2019 to collect all patient records who underwent mini PCNL. Patients were excluded if less than 1.5 cm of stone was treated. The costs assessed were based on a single institutions charges for hospitalization, surgical fees and instruments used during the procedures.RESULTS: In this study, greater than 1.5 cm of stone was treated in 173 of the 189 mini PCNLs. The average age was 53.8, BMI was 32.1, and the population was 54% female. In 53% of cases, multiple stones were present and average stone burden was 2.5 cm (1.5-6.6 cm). Average surgical time was 74 minutes with 28 cc of blood loss. Stents were left in 45% (78/173) of patients and nephrostomy tubes in 24% (42/173). Average date of discharge was postoperative day 0.6 with 63.5% of patients discharged on the day of surgery compared to 2.3 days for PCNL over the same period.

INTRODUCTION AND OBJECTIVES: Upper calyx access in percutaneous nephrolithotomy (PCNL) is an effective route to achieve access to the whole collecting system in complex kidney stone case or in high stone burden. However, it is less preferred or underutilized due to the previously reported high complication rates. Some studies suggest ultrasound to be superior in access upper calyx access. Present study compares the safety and efficiency of ultrasonography-guided versus fluoroscopy-guided upper calyx access in PCNL METHODS: In total, all consecutive PCNL cases in two different institutions were reviewed from 2015 to 2017. Patients with solitary upper calyx access were enrolled into the study. In total 143 patients were recruited into the study. Patients were divided into two groups according to the coupling imaging in access: fluoroscopy-guided (institution A) (n[85) and ultrasonography-guided (institution B) (n [58). Preoperative patients and stone demographics, and complication rates are compared (Table 1-2). RESULTS: Patients and stone characteristics were almost similar in each group (Table 1). However, the stone density was higher in group 1 and they also had high number of multiple stone cases. Both groups complications rates were similar according to the modified Clavien-Dindo Grading System (p>0.05). Fluoroscopy-guided PCNL was similar to ultrasonography-guided PCNL in terms of pleural invasion (9.4 % vs 5.2%), blood transfusion (8.2% vs 12.1%), extravasation requiring DJ insertion (4.7% vs 3.4%) and urinary tract infection ((14.1 % vs 15.5 %) (p>0.05). Fluoroscopy was also used in the control of residual stones in ultrasonography-guided PCNL cases, but the duration of total fluoroscopy and duration of operation were significantly shorter in group 2. CONCLUSIONS: The complications rates in ultrasound coupled PCNL is not better than the ones in fluoroscopy-guided. However, operation time gets shorter and fluoroscopy use decreases with similar stone free rates in ultrasonography-guided PCNL.

INTRODUCTION AND OBJECTIVES: During the last years there has been an effort in miniaturizing the endoscopic devices. The video presents an alternative for the management of distal ureteral stone, using a ureteral access of 4.85Fr and 27cm of length, previously described as micro-ureteroscopy. METHODS: This procedure was performed through a 3-part allseeing needle, consisting of micro-optics 0.9mm in diameter with a 120degree angle of view, an irrigation channel and an integrated light. RESULTS: Seven year-old boy, with history of preterm birth (29 weeks) was referred to our consultation complaining of left back pain and an elevation of serum creatinine. The renal ultrasound revealed a left ureterohydronephrosis, caused by a 10mm stone located 13mm from the ureterovesical junction. The patient underwent a micro-ureteroscopy with laser lithotripsy. The stone was fragmented with an average energy of 0.5J with 12Hz of frequency. The total energy spent was 12514J. At the end of the procedure, a double J stent was placed. The procedure lasted 45 minutes and was uneventful. The patient was discharged 24h after the procedure without complaints and remained stone free. CONCLUSIONS: Micro-ureteroscopy is a safe and effective technique in distal ureteral lithiasis treatment in children. The small dimensions of the equipment increase the safety of the procedure making this a good option for the treatment of ureteral stones in children.

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