Minimally invasive percutaneous nephrolithotomy: an effective treatment for kidney stones in infants under 1 year of age. A single-center experience

Abstract

We aimed to present the outcomes of PNL surgery performed in infantile patients with small renal stones who were younger than 1 year of age. A single-center prospective trial was initiated and during the period between Jan 2013 and Jan 2015, PNL was applied to 20 renal units of 16 infants (6 girls and 10 boys), including 4 patients with bilateral kidney stones. PNL was performed in patients with renal stones larger than 2 cm, as well as stones resistant to SWL or renal stones that were undetectable during SWL. The mean age of the patients was 9.55 (5-12) months. Of the 20 renal units, 1 had complete staghorn stones, 3 had partial staghorn stones, 13 had renal pelvic stones, and 3 had lower pole stones. The mean stone size was 18.5 mm (range 12-36 mm). Mean operative time for PNL was 88 (25-135 min). Mean fluoroscopy time was estimated as 3.4 min. Mean hemoglobin loss was 0.72 g/L (0.2-3). The mean hospital stay was 4.1 days (2-8 days). On postoperative day 1, a complete stone-free state was achieved in 70% of renal units (14 of 20). At the end of the first postoperative week, the remaining two patients had insignificant residual fragments of 3 mm and were followed conservatively without any specific intervention. Thus, the total SFR was 80% (16 of 20) at discharge. In infants aged less than 1 year, minimal access tract dilation during PNL, the use of smaller caliber pediatric instruments, and the realization of this procedure by surgeons with adequate experience in adults carry utmost importance. In addition, special care should be taken to avoid hypothermia and radiation exposure during PNL.

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

“…Our SFR results are comparable to a study conducted in Bangalore in 2021, in which they reported their experience of minimally invasive PCNL in 24 infants, achieving an SFR of 91% ( 25 ). Our SFR results are higher than the study conducted by Dağgülli et al and Bodakci et al in which SFR results were 80% and 81.2%, respectively ( 18 , 26 ). A similar study was conducted in USA by Jackman et al who performed PCNL in eleven infants and preschool children using 11 Fr peel away sheath.…”

“…The overall complication rate in our study is comparable to the study done in Bangalore by Patil et al, which is 16% ( 25 ). However, our complication rate is relatively better than that reported by Dağgülli et al, which was 40%, including bleeding requiring blood transfusion in 10%, fever in 10%, and UTI in 20% of the patients ( 18 ). Our complication rate is also better than that of Bodakci et al, which was 27%, including bleeding requiring blood transfusion in 4.2%, fever in 8.3%, and UTI in 14.6% of the patients ( 26 ).…”

“…Also, a large part of the infant's kidney will be exposed to increased energy, which theoretically can lead to a higher risk of acute renal damage, even though different studies revealed no long-term adverse effects of this exposure ( 17 ). Furthermore, residual stones after ESWL may lead to the recurrence of nephrolithiasis ( 18 ). In our institute ESWL is performed by technicians.…”

18 Yaşından Küçük Pediatrik Hastalarda Uygulanan Farklı Perkütan Nefrolitotomi Prosedürlerinin Değerlendirilmesi

“…Minimal invaziv yöntemlerin 1 yaş altı infantlarda PNL'nin güvenilir uygulanabilmesine imkân tanıdığını belirten Dağgülli ve ark. yapmış oldukları başka bir çalışmada en küçüğü 5 aylık ve yaş ortalaması 9,5 ay olan 1 yaş altı 16 infantta (toplam 20 ünite) 5 hastaya 20 Fr, 15 hastaya 14 Fr dilatasyon yaparak uyguladıkları prosedürde tek seansta %80 başarı elde ettiklerini belirtmiştir (17). Dede ve ark.…”