Our Experience with Totally Ultrasonography-Guided Percutaneous Nephrolithotomy in Children

Abstract

Our experience with totally ultrasonography-guided PCNL using adult size instruments in children revealed proper results and acceptable complications compared with the standard technique of PCNL. Likewise, this alternative method has the advantage of preventing radiation hazard.

Totally Ultrasound-Guided Minimally Invasive Percutaneous Nephrolithotomy in Children

“…In our study, the mean access time was lower than the previously published article (1.50 ± 0.62 min vs. 4.45 ± 2.25 min). [ 4 ] Our explanation to lower access time to the stone was better visualisation of the PCS system by the US and using a one-shot dilatation technique in our study. [ 21 ] In this study, the mean operation time was similar to that of a previous article.…”

“…This method was similar to that of a previous study by Sharifiaghdas et al . [ 4 ] Futhermore, since the one-stage tract dilation technique was highly suggested in previous studies, we performed all mini-PCNL using the same technique. [ 4 20 21 ]…”

“…The echogenicity of the irrigation fluid in PCS may mimic the stone appearance, affecting our judgement in evaluating the residual stones at the end of the procedure, which is a significant step in mini-PCNL. [ 4 ]…”

“…PCNL has been gradually adopted in children and is considered an option in children with renal stones. [ 4 ] Several series have been described using the paediatric mini-PCNL technique with acceptable SFR. [ 5 ]…”

Total tubeless percutaneous nephrolithotomy without artificial hydronephrosis in preschool children: Three case reports

“…In current studies on PCNL for the treatment of pediatric stones, intraoperative ureteral catheters need to be left in place, through which saline can be injected to establish an artificial hydronephrosis dilated collecting system, which can reveal the dome of the target calyces and improve the success rate of the puncture, especially for patients with stones without hydronephrosis. [ 3 ] In addition, it has the effect of preventing the downward migration of stones to avoid a secondary ureteral extraction. However, there are several disadvantages to this operation; If the child has a twisted ureter or ureteral stenosis, it will lead to the failure of ureteral catheterization; The immune system of the child is not sound, and the high pressure of the retrograde saline infusion will easily lead to bacterial re-infiltration into the blood, increasing the incidence of postoperative infection [ 4 ] ; Retrograde infusion of saline or contrast agent will lead to extravasation of fluid or contrast agent, [ 5 ] which in turn can affect their imaging under ultrasound; The child’s position needs to be changed twice during the procedure, which prolongs the operation time and increases the risk of infection; and The anatomical features of the child are smaller, and the urethra and ureter are thinner and more curved than those of adults, which increases the risk of damaging the ureter and urethra, resulting in postoperative ureteral stricture.…”