Outcomes of mini-percutaneous nephrolithotomy in children: a single centre experience

Kandemir, Abdülkadir; Balasar, Mehmet; Pişkin, Mehmet Mesut; Öztürk, Ahmet

doi:10.5173/ceju.2019.1672

Cited by 4 publications

(2 citation statements)

References 21 publications

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“…Использование методик мини-ПНЛ и ультрамини-ПНЛ позволяет снизить степень интенсивности травматического воздействия на чашечно-лоханочную систему (ЧЛС) почки во время манипуляции, что, в свою очередь, снижает вероятность и выраженность интраоперационного кровотечения и гематурии в раннем послеоперационном периоде [18 -21]. Миниатюрные хирургические инструменты обеспечивают возможность формирования перкутанного доступа меньшего диаметра и выполнения более деликатных дальнейших действий по разрушению камня в чашечно-лоханочной системе, уменьшая риск значимого кровотечения [22][23][24][25][26]. Чаще всего были выявлены инфекционно-воспалительные и геморрагические осложнения.…”

Section: Discussionunclassified

Percutaneous nephrolithotripsy in children using miniature instruments.

Vardak,

Arustamov,

Rudin

et al. 2023

ECU

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Introduction. Currently, percutaneous nephrolithotripsy is the main treatment for large and coral-like kidney stones in children. The purpose of the study was to increase the effectiveness of percutaneous nephrolithotripsy (PCNL) in children using miniature-sized instruments. Materials and methods. For the period from 2008 to 2019, 320 children aged 1 to 17 years underwent nephrolithotripsy in the pediatric department of the N. Lopatkin Scientific Research Institute of Urology. Depending on the size of the instruments used, patients were divided into 3 groups. The first group included children who underwent surgery using the Mini-PCNL technique (n-211), the second group included patients operated on using the Ultra-Mini-PCNL method (n-16) and the third group included children whose percutaneous intervention was performed using a standard-sized nephroscope (n-93). The intervention was carried out according to the standard method; all patients underwent cystoscopy, catheterization of the ureter, access formation, lithotripsy, lithoextraction and installation of nephrostomy drainage. Results. In the first group of children studied, complete elimination of clinically significant stones (residual stones smaller than 4 mm) after the initial intervention was achieved in 169 (80.1%) pediatric patients. In the second group, there was 13 (81.2%) children. And in the third group, getting rid of stones was achieved in 73 (78.5%) patients. The average time required to perform surgery in all three study groups was comparable and amounted to 45 (40-125) minutes in the first group, 40 (25-85) minutes in the second, and 50 (40-180) minutes in the third group. The final efficacy of percutaneous nephrolithotripsy in children using instruments of various sizes in the first group was 89.6%, in the second – 93.7% and 88.1% in the third study group. The hospital stay after surgical treatment was: 4 (3-12) days for the first group, 3.5 (3-7) and 4.5 (3-17) days for the second and third groups, respectively. The need for additional interventions after PCNL in pediatric patients was in 69 (32.7%) children in the first group, 4 (25%) in the second and 41 (44.1%) in the third group. Conclusion. The use of mini-PCNL, ultra-mini-PCNL can reduce the duration of surgical intervention by 10% and 20%, the hospital stay after PCNL by 11.2% and 22.3%, the need for additional interventions by 11.4% and 19.1%. Can reduce the total number of complications by 10% and 12.2%, respectively, compared with the use of standard-size instruments. The use of Mini-PCNL in children is indicated in the younger and middle age groups, Ultra-Mini-PCNL is indicated for single stones up to 2 cm or as an additional access in the multi-accesses formation.

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Section: Discussionunclassified

Percutaneous nephrolithotripsy in children using miniature instruments.

Vardak,

Arustamov,

Rudin

et al. 2023

ECU

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“…Выполнение ПНЛ с использованием «безнефростомной» методики позволяет снизить риск указанных состояний. Данный вид лечения идеально подходит в случае достижения полного удаления конкремента размером 1,5-3 см при отсутствии бактериуриии и без явлений интенсивного кровотечения в финальной стадии ПНЛ[30][31][32][33][34][35]. Предпочтительно дренирование верхних мочевых путей в послеоперационном периоде за счет установки внутренних и наружных мочеточниковых стентов.…”

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The use of tubeless percutaneous nephrolithotripsy in children.

Vardak,

Arustamov,

Rudin

et al. 2023

ECU

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Introduction. Currently, percutaneous renal surgery is a common surgical procedure in urologic practice for the treatment of large and staghorn renal stones. Placement of a nephrostomy tube has been well recognized as a standard procedure to provide hemostasis, adequate drainage, and access for additional endoscopic procedures. At the same time, the use of a nephrostomy tube has negative consequences such as discomfort/pain symptom, longer hospital stay and possible urine extravasation. In view of the above, draining of the access tract raises questions in some cases. The aim of the study was effectiveness of tubeless percutaneous nephrolithotripsy in the treatment of urolithiasis in children. Materials and methods. Between 2013 and 2019, 66 patients (aged 1-17 y/o) underwent tubeless percutaneous nephrolithotomy (PNL) at the Department of Pediatric Urology of N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology. Patients were divided into three groups depending on the size of the instruments and the way the operation was completed. The first group (n=28) underwent surgery using the mini-PNL technique with the closure of the access tract. The second group (n=21) underwent surgery using the mini-PNL technique in the end of the surgery, moderate bleeding along the tract was detected in order to stop bleeding, a hemostatic matrix with thrombin was introduced. The third group (n=17) underwent surgery using the standard PNL technique and moderate bleeding was also determined in this group with the aim of tubeless completion, a hemostatic matrix with thrombin was introduced. Drainage of the upper urinary tract in the postoperative period was carried out by "JJ"-internal and "J"-external ureteral stents, which were held for up to 14 days. Results. The complete removal of the calculus in one surgical session was similar in all three groups. In the first group there were 26 (92.8%) children, in the second group 19 (90.4%) and in the third group 16 patients (94.1%). In the first group it was 26 (92.8%) children, in the second group 19 (90.4%) and in the third group 16 patients (94.1%). The need for additional interventions after surgical treatment was 21.4% in the first group, 23.7% in the second and 17.5% in the third group. Febrile fever (persistent temperature 380 C) most often occurred in the first group – in 10.7% of cases, while in the second and third groups this complication was detected in 4.7% and 5.8% of cases, respectively. Gross hematuria in the postoperative period was noted in the group without the use of a hemostatic matrix, averaging 35 (2-115) hours. Conclusion. The proposed tubeless PNL with the use of a hemostatic matrix is indicated for children without bacteriuria, with complete removal of the calculus, in the absence of trauma of the pelvicalyceal system and intensive bleeding. The duration of gross hematuria decreased with the introduction of the matrix in standard tubeless PNL by 51.4% and in mini-PNL by 25.8% compared with the 1-st group

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A comparative analysis of the efficacy and safety of mini-percutaneous nephrolithotomy performed in the supine and prone positions for the treatment of pediatric kidney stones: a single-center experience

Bitkin,

Özlü,

Ekşi

et al. 2023

Urolithiasis

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AimMini-percutaneous nephrolithotomy (MPCNL), which has a smaller tract size (14-20 Fr) than conventional percutaneous nephrolithotomy, has been shown to be safe and effective in pediatric patients with large and complex upper urinary tract stones. This study aimed to compare the e cacy and safety of MPCNL between the supine and prone positions in a pediatric population. MethodThe data of pediatric patients who underwent MPCNL at our center between January 2010 and March 2023 were retrospectively analyzed. According to the surgical position, the patients were divided into the prone (Group P) and supine (Group S) groups. In both groups, dilatation was performed using 14-18Fr metallic dilators. The two groups were compared in terms of perioperative data, postoperative stone-free rates (SFRs), and complications. ResultsThere were 36 (59%) patients in Group P and 25 (41%) patients in Group S. Stones were mostly located in the pelvis (49.2%) and second most frequently in the lower pole (27.9%). Fluoroscopy time was shorter in Group S but did not statistically signi cantly differ compared to Group P (p = 0.181). However, operation time was statistically signi cantly shorter in Group S (73.8 ± 35 vs. 99.8 ± 37.4 min, p = 0.008). Although there was no signi cant difference, relatively higher SFR were detected in Group S (88% vs. 83%, p = 0.725). Endoscopic combined intrarenal surgery (ECIRS) was performed on six (24%) patients in Group S, and the SFR was 100% among these patients. There was no signi cant difference between the two groups in terms of the presence of complications (16.7% vs. 16%, p = 0.945). ConclusionBoth supine and prone MPCNL appear to be safe and effective in the pediatric age group, with similar stone-free and complication rates. In the supine procedure, the operation time is shortened compared to the prone. In addition, simultaneous retrograde access has the potential to increase the overall success rate of surgery.

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Outcomes of mini-percutaneous nephrolithotomy in children: a single centre experience

Cited by 4 publications

References 21 publications

Percutaneous nephrolithotripsy in children using miniature instruments.

Percutaneous nephrolithotripsy in children using miniature instruments.

The use of tubeless percutaneous nephrolithotripsy in children.

A comparative analysis of the efficacy and safety of mini-percutaneous nephrolithotomy performed in the supine and prone positions for the treatment of pediatric kidney stones: a single-center experience

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