Percutaneous nephrolithotomy 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

Mini-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 efficacy and safety of MPCNL between the supine and prone positions in a pediatric population. The 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 14-18 Fr metallic dilators. The two groups were compared in terms of perioperative data, postoperative stone-free rates (SFRs), and complications. There 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 significantly differ compared to Group P (p = 0.181). However, operation time was statistically significantly shorter in Group S (73.8 ± 35 vs. 99.8 ± 37.4 min, p = 0.008). Although there was no significant 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 significant difference between the two groups in terms of the presence of complications (16.7% vs. 16%, p = 0.945). Both 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.

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

RATIONALE

Indwelling ureteral catheter, double J tube, or nephrostomy tube are routine procedures for percutaneous nephrolithotomy (PCNL) in children. There are a few cases in which PCNL has been performed in children without any additional instruments being left in place.

PATIENT CONCERNS

In this study, 3 children were treated for hematuria and complicated with different degrees of urinary tract infection. All of them were diagnosed as upper urinary tract calculi by abdominal computed tomography.

DIAGNOSIS

Three preschoolers were diagnosed with upper urinary tract calculi before surgery, one with no hydronephrosis and the other 2 with different degrees of hydronephrosis.

INTERVENTIONS

After preoperative evaluation, all the children successfully completed PCNL without indwelling ureteral catheter, double J tube, or nephrostomy tube.

OUTCOMES

The operation was successful and there were no residual stones observed during postoperative review. The operating times for the children were 33 minutes, 17 minutes, and 20 minutes, and the intraoperative bleeding volumes were 1 mL, 2 mL, and 2 mL. The catheter was removed on the second day after the operation, the postoperative review of the abdominal computed tomography or ultrasound did not indicate any stone residue, and there were no fever, bleeding, and other related complications after the operation.

LESSONS

We believe that total tubeless PCNL without artificial hydronephrosis can be achieved in the preschool population.

Comparison between prone and supine nephrolithotomy in pediatric population: a double center experience

PURPOSE

Stone disease in the pediatric age is an increasing issue. Percutaneous Nephrolithotomy (PNL) can be used for larger and complex stones. As in adults it can be performed in the supine or prone position.

METHODS

We retrospectively reviewed two centers' experience in prone and supine PNL in children to analyze its results and complications.

RESULTS

33 patients underwent prone and 19 supine procedures. Patients in the prone group were younger than in the supine, while no significant differences were found in stone burden, access size, operative time or complications. Complications were: 8 and 4 Clavien 1 for the prone and supine group, respectively, one case of urosepsis (4b) in the prone and 2 cases of Clavien 3 in the supine group (double J stent placement for renal colic and ureteroscopy for steinstrasse). Tubeless procedures and mean nephrostomy time were in favor of the supine group, whereas fluoroscopy time and ureteral drainage stay were in support of the prone group. Stone free rate was better in the supine group (83.3 vs 66.6%), possibly reflecting the capability to perform a combined approach in 12 patients (allowing to reach all the calyx with simultaneous anterograde and retrograde access) or younger age in the prone group (13 vs 2 patients ≤5 years), with no differences in stone burden.

CONCLUSIONS

Supine approach seems to guarantee higher stone-free rates. Larger series are necessary to determine what the best technique is in terms of X-ray exposure, operative time and complications.

Paediatric stone management: innovations and standards

PURPOSE OF REVIEW

The aim of this study was to discuss current trends and recent developments in the surgical management of paediatric urolithiasis.

RECENT FINDINGS

Medical expulsive therapy (MET) is considered as an option for the treatment of children with ureter stones. Extracorporeal shockwave lithotripsy (SWL) remains as a first option for majority of kidney stones and upper ureter stones. Advances in endourology have led to increased adoption of retrograde intrarenal surgeries (RIRS) and percutaneous nephrolithotomy (PCNL/mini-PCNL/ultra-mini-PCNL/micro-PCNL).

SUMMARY

Management of paediatric stone disease has developed significantly in the past decade. However, the evidence in the literature remains disproportional to these advances. Well designed multicentric studies are still needed to compare effectiveness and safety of these procedures.