Minipercutaneous nephrolithotomy in infants: a single-center experience in an endemic region in Turkey

Abstract

The objective of the study is to evaluate the effectiveness and safety of miniaturized percutaneous nephrolithotomy (mini-PNL) method in infantile patients <3 years of age diagnosed with renal stones. We studied 48 renal units in 40 patients of infantile patients <3 years of age who underwent mini-PCNL at our institute. The mean age of the patients was 24.02 (5-36) months. The mean diameter of the stones was 22.3 mm (11-45 mm). Intrarenal access was achieved under fluoroscopic (n = 43) or ultrasonographic (n = 5) guidance under general anesthesia. A 20 Fr peel-away sheath, a 17 Fr rigid nephroscope and a pneumatic intracorporeal lithotripsy were used. Mean operative time for PNL was 85 (25-135) min. Mean fluoroscopy time was estimated as 3.7 min. The mean hospital stay was 4.3 days (2-10). Mean hemoglobin loss was 0.89 g/L (11.56-10.67) and three of the patients, including one case during the perioperative period, required blood transfusions. Colonic perforation developed in one case. In two patients, urinary drainage persisted for more than 24 h after withdrawal of the nephrostomy tube. Seven patients developed urinary tract infections (UTI). At the end of the postoperative first week, the stone-free rate was estimated to be 81.2 %. In conclusion, for percutaneous management of renal stones in the infantile age group, mini-PNL is an applicable treatment modality that can be applied through small incisions. It has higher stone-free rates, shorter hospital stays, and excellent esthetic outcomes. In this age group especially, surgical exposure to hypothermia and radiation should be avoided.

Outcomes of miniaturized percutaneous nephrolitotomy in infants: Single centre experience

“…As it was in our study, Bodakci et al used only pneumatic lithotoripsy for fragmentation and SFR was 81.2% in their series (20). Brodie and Bo Xiao et al used both pneumatic and laser lithotripsy for fragmentation depending on the surgeon's preference and SFR was 76% and 92.5% in their studies,respectively (21,22).…”

“…Pediatric patients were more likely to bleed during system dilatation because of the fragile renal parenchyma and delicate collecting system. In mini PNL series of infancy, blood transfusion rates were lower than the pediatric age patients and varied between 0% and 7.5% (20,21). Studies showed that blood transfusion rates were higher with the use of 24-26Fr sheaths than with ≤18Fr (5.9%) sheaths (24).…”

“…Success rate of mini PNL procedure in recent infant series varies between 70.8-92.5% after single session and 81.2-92.5% after additional session. Bodakci et al showed that stone free rate was 70.8% at the end of the posto-perative 24 hour and 81.2% at the end of the first postoperative week in 48 infant mini-PNL procedures (20). Bo Xiao et al performed all mini-PCNL with ultrasound-guidance in 67 renal units of 56 patients aged <3 years.…”

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

“…Unlike in adults and in older children, the management of large stones in infants requires a high level of performance and experience; we believe that an SFR of 80 % for PNL monotherapy in infants (<1 years) is acceptable. Generally, higher SFRs (73-96 %) have been reported in PNL series in the pediatric age group [6,16,17]. Bodakçi et al reported SFRs of 81.2 % in infantile patients less than 3 years of age using mini-PNL monotherapy [17].…”

Is standard percutaneous nephrolithotomy still the standard treatment modality for renal stones less than three centimeters?

“…If PNL procedure is performed with an access sheath of 12F-20F diameter; this procedure is called miniaturized percutaneous nephrolithotomy (mPNL). [4,5] Although described as a minimally invasive technique, PNL has some serious potential complications such as fever, septicemia, adjacent organ injury and bleeding. [6,7] In general, bleeding is limited without the further need of any intervention or manipulation but in some cases blood transfusion, super-selective renal angiography and embolization, open exploration or nephrectomy might be required.…”