Is mini-percutaneous nephrolithotomy a safe alternative to extracorporeal shockwave lithotripsy in pediatric age group in borderline stones? a randomized prospective study

Farouk, Ahmed; Tawfick, Ahmed; Shoeb, Mohamed Ayman; Mahmoud, Mahmoud A.; Mostafa, Diaa Eldin; Hasan, Mohamed; Abdalla, Hany M.

doi:10.1007/s00345-018-2231-9

Cited by 20 publications

(5 citation statements)

References 30 publications

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“…Different studies were conducted in which they compared the SFR of mini-PCNL and ESWL for 1–2 cm stone in the pediatric population. The SFR after first session was 88.9% for PCNL and 55.6% for ESWL ( P = 0.006) ( 28 ). Another study was done in China on 46 infants in which they compared the SFR of mini-PCNL and ESWL in infants under three years of age.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of minimally invasive percutaneous nephrolithotomy for infantile nephrolithiasis. Single centre experience from Pakistan

Ahmad

Minallah²,

Khaliq³

et al. 2023

Front. Pediatr.

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ObjectiveTo assess the efficacy and safety of mini-percutaneous nephrolithotomy (PCNL) for small renal stones 1–2 cm in size in infants less than one year.Material and MethodsThis descriptive case series was conducted in the department of pediatric urology Institute of Kidney Diseases Peshawar, Pakistan, from March 2019 to March 2022. All the patients underwent mini-PCNL in prone position under GA with 14 Fr access sheath and 10 Fr nephroscope. Stone clearance was assessed by non-contrast CT KUB at 30th postoperative day. Patients with no residual fragments on the non-contrast CT KUB were defined as stone-free. Patients with residual fragments of any size were defined as procedure failure. Safety was determined in terms of intra and postoperative complications.ResultsA total of 51 infants were included in the study. The mean age of patients was 9.6 + 1.8 (5–12 month). The mean stone size was 15.8 + 2.7 (10–21) mm in length and 12.3 + 2.2 (8–17) mm in width. PCNL mean operative time was 51.6 ± 7.1 (40–70) minutes. Complete stone clearance at one month was observed in 46 (90.2%) patients. Residual fragments were seen in 5(9.8%) patients with a mean size of 1.6 + 0.4 (0.9–2.0) mm. None of the patients required any additional procedure for clearance of stones. In 7 (13.7%) patients, some post-operative complications were observe, all were grade I complications, including fever in 5(9.8%) and transient hematuria in 2(3.9%) patients.ConclusionMini-PCNL is a safe and effective treatment for renal stones in infants measuring 1–2 cm with high SFR and an acceptable complication rate.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of minimally invasive percutaneous nephrolithotomy for infantile nephrolithiasis. Single centre experience from Pakistan

Ahmad

Minallah²,

Khaliq³

et al. 2023

Front. Pediatr.

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“…We had early SFR about 90% and total SFR 95.3%, which was higher than other studies, and 5.3% residual stone fragment. Farouk et al ( 26 ) performed a prospective study on 108 pediatric patients with 1- to 2-cm renal stone and randomized them into two groups to compare MPCNL and ESWL. Those who underwent MPCNL had 88.9% SFR after the first session surgery and reached 92.59% SFR after the second-look PCNL.…”

Section: Discussionmentioning

confidence: 99%

“…Those who underwent MPCNL had 88.9% SFR after the first session surgery and reached 92.59% SFR after the second-look PCNL. However, the ESWL group had 55.6% after the first session and reached 88.89% SFR after the third session of ESWL ( 26 ). Another study compared the outcomes of super-MPCNL and retrograde intra-renal surgery (RIRS) for children with upper urinary tract calculus.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Mini-Percutaneous Nephrolithotomy in Patients Under the Age of 18: An Experience With 112 Cases

et al. 2021

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Purpose: Renal calculi are becoming more common among children. Although, extracorporeal shock wave lithotripsy (ESWL) is the first choice in this age group, minimal invasive surgeries, such as percutaneous nephrolithotomy (PCNL), are indicated for some patients. Recently, PCNL devices have become smaller in size with acceptable efficacy and lower complications. We evaluated the outcomes and complications of mini-PCNL (MPCNL) surgery in our referral training centers.Materials and Methods: Between September 2012 and January 2020, a total of 112 children under the age of 18, who had shown failure of ESWL, and/or their parents refused to do it, underwent MPCNL (15 Fr). The patients' profiles were reviewed for data collection including preoperative and stone data, operation information, and postoperative complications.Results: Of 112 patients, 69 were boys, and 43 were girls. Their mean age was 8.6 years (14 months to 18 years). Mean stone size was 20 mm (14–34 mm). Seventy-four cases had renal pelvic stone, 22 had pelvis and lower pole, and 16 had staghorn. The mean operation time was 65 min (35–100 min), and mean radiation time was 0.6 min (0.2–1.4 min). Low-grade fever was detected in 14 patients (12.5%). Four patients needed blood transfusion and two had increased creatinine, which improved with conservative management. One patient developed urosepsis that resolved with antibiotic therapy. None of the patients had kidney perforation or other organ injury or death. Early stone-free rate (SFR) after operation was 90.2% (101 patients). Six patients had residual fragment <5 mm, which passed spontaneously in 2 weeks after operation (total SFR 95.3%). Three patients underwent second-look nephroscopy, and ureteroscopy was done for two patients due to migrated stone fragments to the distal ureter.Conclusion: MPCNL is recommended as a safe alternative option for treatment of the nephrolithiasis in children with good outcome and acceptable complications.

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“…12,19 Even though, some studies reported a lower SFR. 20 The predictors of the stone-free rate after PCNL were studied in literature. To illustrate, Shahror, K, et al reported that the stone size, number, location, and pelvicalyceal system anatomy were significant predictors of SFR.…”

Section: Discussionmentioning

confidence: 99%

The feasibility of one-day length of hospital stay after pediatric percutaneous nephrolithotomy

et al. 2021

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Purpose: To evaluate the safety of one-day length of hospital stay (LOS) after pediatric percutaneous nephrolithotomy (PNL), and to study the predictors of LOS. Methods: A retrospective study included pediatric patients who PNL for renal calculi more than 1 cm between January 2016 and October 2019. PNL was performed in prone position. The nephrostomy tubes and ureteric catheters were removed on the second day and patients were discharged if there was no perforation or significant residual stones. The stone free rate, LOS and the surgical complications were reported. Bivariate and multivariate analysis were used to predict the LOS. Results: 220 patients were identified. The median age (range) was eight (Range: 3–17) years. Stone free rate was achieved in 200 patients (91%) of patients, while residual fragments were detected in 20 patients (9%). Complications, they were reported in 50 (22.7%) patients. 184 (83.6%) of patients stayed at the hospital for only 1 day, while 36 (16. 4%) stayed more than 1 day. Of 36 patients who stayed more than one-day, 34 had complications ( p value <0.001). On multivariate analysis, surgical complications was found to be the only predictor of longer LOS ( p value <0.001). Conclusion: Early nephrostomy tube removal and 1-day length of hospital stay could be a safe option after pediatric PNL. Surgical complications is a statistically significant predictor of longer LOS.

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Is mini-percutaneous nephrolithotomy a safe alternative to extracorporeal shockwave lithotripsy in pediatric age group in borderline stones? a randomized prospective study

Abstract: According to Clavien grade of complications mini-PCNL is a safe procedure, and after three session of ESWL, mini-PCNL has a similar stone-free rate with a lower retreatment rate. However, the mini-PCNL has more radiation exposure, and requires a longer hospital stay.

Cited by 20 publications

References 30 publications

Safety and efficacy of minimally invasive percutaneous nephrolithotomy for infantile nephrolithiasis. Single centre experience from Pakistan

Safety and efficacy of minimally invasive percutaneous nephrolithotomy for infantile nephrolithiasis. Single centre experience from Pakistan

Outcome of Mini-Percutaneous Nephrolithotomy in Patients Under the Age of 18: An Experience With 112 Cases

The feasibility of one-day length of hospital stay after pediatric percutaneous nephrolithotomy

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