Minimal invasive percutaneous nephrolithotomy (Mini-PCNL) in children: Ultrasound versus fluoroscopic guidance

Abstract

Background: Miniaturization of endoscopic instruments in percutaneous nephrolithotomy (PCNL) allowed less invasive procedures with low complication rates, especially in children. This study was conducted to evaluate the safety and efficacy of ultrasonography-guided (USG) versus fluoroscopy-guided (FG) mini-PCNL in children.Materials and methods: This is a retrospective comparative study conducted from June 2015 to June 2020. The sample included 70 children (35 pateints underwent USG mini-PCNL and 35 pateints underwent FG mini-PCNL). They were compared mainly by the patients’ demographic characteristics, procedural information, and post-treatment outcomes. In the USG mini-PCNL group, puncturing was performed using a 3.5 MHz US probe, whereas fluoroscopy was utilized in the FG mini- PCNL group. Results: Both groups were comparable in terms of gender, previous history of failed ESWL, and hydronephrosis grade. The mean stone burden was 15.94 ± 3.69 mm and 19.20 ± 7.41 mm in USG and FG groups, respectively (p = 0.024). The stonefree rate (SFR) was 97.1% in the USG group and 94.3% in the FG group, which was not statistically significant (p = 0.16). Mean operative time in the USG group and FG group was 69.00 ± 13.33 minutes and 63.48 ± 16.90 minutes, respectively. Four (11.4%) patients in the FG group required blood transfusions to restore the hemodynamic state (p = 0.039). Fever was detected in 4 (11.4%) patients in the USG group and 15 (31.4%) patients in the FG group (p = 0.041). Conclusions: In children, mini PCNL under USG is safe and as effective as fluoroscopy.

Mini-percutaneous nephrolithotomy via ultrasound guidance in transplanted kidney: a report of two cases

“…Warm saline solution was performed as irrigation to avoid hyponatremia and hypothermia. The US confirmed the operation's stone-free status at the end [ 8 , 9 ]. The previous nephrostomy tube was left at the end of the procedure ( Figure 2 ).…”

“…Conventional PCNL procedure for treating stones in the transplanted kidneys has been a well-accepted therapeutic intervention explained by numerous surgeons over the last decade [ 1 , 6 , 8 ]. However, information regarding mini-PCNL for transplanted kidneys is limited, with few reports.…”

“…In our cases, we used US-guided mini-PCNL. The advantages of US-guided mini-PCNL include continuous monitoring of the deeper structures and vessels during the operation, accurate estimations in access to the stone, no exposure to radiation to the staff, and no need for contrast injection [ 8 ]. Because the tract to the collecting system is shorter in pediatric and adolescent cases than in adults, the US facilitates safer tract dilation and exact needle placing to the PCS [ 8 ].…”

The safety and efficiency of a 1470 nm laser in obtaining tract hemostasis in tubeless percutaneous nephrolithotomy: a retrospective cross-sectional study

“…Although a systematic review revealed no significant difference between ultrasonography and fluoroscopy regarding bleeding [ 15 ], we prefer ultrasonography-guided PNL, because the advantages of using the ultrasonography for guidance include decreased exposure to radiation and lower overall cost, decreased operation time and detection of radiolucent stones [ 16 , 17 ]. Moreover, it is useful for decreasing the rate of visceral injury due to better visualization of the surrounding viscera and the depth of needle penetration, and for avoiding vascular injury by adding Doppler flow imaging [ 18 ]. In the present study, we conducted ultrasonography-guided PNL for all the patients.…”

Pediatric Urolithiasis: Current Surgical Strategies and Future Perspectives

“…In 2020, Baydilli et al ( 11 ) reported their single-institution experience in 206 pediatric patients undergoing mini-PCNL for kidney stones with a success rate of 80.6% after the first session, increasing to 87.9% after auxiliary treatments. In a following study comparing the efficacy and the safety of ultrasonography-guided vs. fluoroscopy-guided “mini-PCNL” in children, Eslahi et al ( 12 ) reported higher stone-free rates: 97.1% in the ultrasonography-guided group ( n = 35 patients) and 94.3% in the fluoroscopy-guided group ( n = 35 patients). Similar results were published more recently: Mahmood ( 13 ) in 143 patients experienced a 92.4% of stone-free rate after a single “mini-PCNL” session independently by patient's age.…”