Mini-Percutaneous Nephrolithotomy for Complex Staghorn Stones in Children

Abstract

Objectives: To evaluate the safety and efficacy of percutaneous mini-nephrolithotomy (mini-PCNL) in children with complex staghorn stones. Patients and Methods: We analyzed prospectively data of 28 children undergoing pediatric mini-PCNL during a period of 18 months. Stone complexity was defined according to the validated Guy’s stone score (GSS). Our patients were GSS III and IV. All PCNL procedures were performed in the prone position, under fluoroscopic guidance, and in the same standardized fashion with F12 and F17 mini-nephroscopes. Results: Eleven children were boys (total n = 28). Mean age was 7.25 ± 3.27 (2–14) years. Mean stone burden was 36.89 ± 8.002 (30–60) mm. GSS was in 57% grade III and in 43% grade IV. The initial stone-free rate was 78%, which increased to 89% after few ancillary procedures. Seventeen percent of children had major complications (1 hydrothorax, 4 blood transfusions). On statistical analysis, stone clearance rates were found inversely dependent on stone complexity (GSS; p < 0.025). Stone burden, number of tracts, and procedure time were associated with stone complexity (p < 0.000). In turn, stone complexity (p < 0.015) and the number of tracts (p < 0.049) were significantly associated with complications. Conclusion: Mini-PCNL is effective and safe for treating complex renal stones in pediatric patients. Complication rates are acceptable and predictably stable on comparison with the literature.

Effect of Percutaneous Nephrolithotomy Combined with Needle Nephrolithotomy on Renal Function and Complication Rate in Patients with Complex Renal Calculi

“…(1) e perioperative conditions of the two groups were statistically analyzed, including the length of operation, intraoperative blood loss, stone clearance rate, length of hospital stay, and degree of pain, and the degree of pain was assessed according to the VAS scale, with a total of 10 points, and the lower the score, the better. (2) e levels of renal function (blood urea nitrogen (BUN), serum creatinine (Scr), and cystatin (C) were measured before and 1 d after operation in both groups. (3) e levels of inflammatory factors (C-reactive protein (CRP), procalcitonin (PCT)) before surgery and 1 d after surgery were counted in both the groups.…”

“…Complex kidney stones are mainly staghorn-shaped or multiple and large stones with a diameter of ≥2.5 cm. In general, stones are numerous, widely distributed, and difficult to remove, posing a great threat to the quality of life and physical and mental health of patients [ 1 , 2 ]. Therefore, timely, safe, and effective treatment for patients with complex kidney stones is of great significance.…”

Comparative Study of Externalized Ureteral Catheter Versus Double-J Stent on Percutaneous Nephrolithotomy: A Randomized Controlled Trial

“…The worldwide prevalence, incidence, and composition of calculi vary and in Asia, 1-19.1% of the population suffers from urolithiasis [ 2 , 3 ]. With the advances of surgical technology, less invasive procedures such as percutaneous nephrolithotomy (PCNL) have gradually become a preferred therapy for urinary stones [ 4 , 5 ]. Since its introduction, a variety of alterations and improvements has been made to the procedure in order to achieve maximum stone clearance along with decreasing the morbidity in patients, postoperative analgesic requirement, and postoperative hospital stay [ 6 , 7 ].…”

Role of Preoperative Renal Stone Complexity Assessment by Guy’s Stone Score as a Predictor of Percutaneous Nephrolithotomy Outcomes

“…On other hand, Kumsart et al [20], found a significant relationship between GSS and postoperative complications but not with SFR. Rashid et al [27] extended the application of GSS to grade the stone complexity in pediatric population in their study to evaluate the safety and efficacy of percutaneous mini-nephrolithotomy (mini-PCNL).…”