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Is percutaneous nephrolithotomy effective and safe for children with solitary kidney? Pediatr Surg Int 2022; 38:1171-1175. [PMID: 35704082 DOI: 10.1007/s00383-022-05147-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of percutaneous nephrolithotomy (PCNL) in pediatric patients with solitary kidneys and kidney stones. METHODS Thirty-nine patients (group A) with solitary kidney under 18 years of age who underwent PCNL between January 2015 and December 2021 were evaluated and analyzed. Forty-two patients (group B) with bilateral kidneys who underwent PCNL were determined as the control group and included in the analysis. Intraoperative and postoperative data such as demographic data, stone localization, bleeding and transfusion rates, operation time, complications, hospital stay, stone-free rates (SFR) and kidney function (glomerular filtration rate (eGFR)) were compared between the two groups. PCNL was performed with all patients in the prone position. Only a laser was used to fragment the stone in all cases. Stone-free was defined as the absence of residual stone fragments ≥ 2 mm in maximum diameter at 3 months on kidney, ureter and bladder (KUB) graphy, ultrasonography (US) or non-contrast tomography (NCCT). RESULTS The mean ages of the patients in Group A and B were 7.5 ± 2.6 and 8.5 ± 3.1 years, respectively. The mean stone size was 16.5 ± 4.1 and 17.0 ± 3.2 mm in group A and group B, respectively (p = 0.49). SFR rates in Groups A and B were 97.4% and 95.2% (p = 1.00). There was no statistically significant difference in terms of the operation time, perioperative blood transfusion, hemoglobin decrease and Clavien grade 1 complication rates (p > 0.05). However, double-J (JJ) stent placement, duration of nephrostomy and hospital stay were longer in the solitary kidney group (p < 0.05). There was a significant improvement in creatinine and eGFR levels in both groups at the postoperative sixth month (p < 0.05). CONCLUSION Our results show that PCNL is a safe and effective method in pediatric patients with solitary kidneys.
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2
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Haberal HB, Dogan HS, Citamak B, Hazir B, Altan M, Bilen CY, Tekgul S. Outcomes of Percutaneous Nephrolithotomy in Preschool Age Group: A Single-Center Study. J Endourol 2020; 34:1001-1007. [DOI: 10.1089/end.2020.0087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Hasan Serkan Dogan
- Division of Pediatric Urology, Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Burak Citamak
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Berk Hazir
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mesut Altan
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Cenk Yucel Bilen
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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Hong Y, Ye H, Yang B, Xiong L, An L, Ma K, Xia M, Huang X, Xu Q. Ultrasound-Guided Minimally Invasive Percutaneous Nephrolithotomy is Effective in the Management of Pediatric Upper Ureteral and Renal Stones. J INVEST SURG 2020; 34:1078-1082. [PMID: 32401098 DOI: 10.1080/08941939.2020.1764154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim: To evaluate the outcome of ultrasound (US)-guided minimally invasive percutaneous nephrolithotomy (MPCNL) in the management of upper ureteral and renal stones in pediatric patients.Methods: We collected data of 112 pediatric patients who were admitted to the xxxx between March 2006 and December 2016 and treated by US-guided MPCNL. Our cohort included upper ureter stones (n = 11), single kidney stones (n = 46), multiple kidney stones (n = 56), and staghorn kidney stones (n = 12).Results: Patients were between 0.5 and 13 years old with stone sizes from 10 to 50 mm. Operation duration ranged from 15 to 195 minutes. On average, the nephrostomy tube could be removed after 3.9 days and patients were discharged after 6.5 days. We found that hemoglobin concentration decreased in 34 patients after surgery by 1 to 37.8 g/L. Using US-guided MPCNL, the initial stone-free rate (SFR) was 86.4% and resulted in a final SFR of 95.2%. However, postoperative complications occurred in 18 patients including > 38.5 °C fever in 17 cases and reactive pleural effusion in one case. Blood transfusion was not required in all cases and no sepsis, kidney loss, ureteral stricture, and adjacent organ injury were observed. Follow-up after an average of 8.5 months showed normal renal function without hydronephrosis. However, recurrence of stones > 4 mm was found in 11 patients.Conclusions: US-guided MPCNL showed an excellent SFR and low complication rate in the management of pediatric patients with upper ureteral and renal stones.
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Affiliation(s)
- Yang Hong
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University Applied Lithotripsy Institute, Beijing, China
| | - Haiyun Ye
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University Applied Lithotripsy Institute, Beijing, China
| | - Bo Yang
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University Applied Lithotripsy Institute, Beijing, China
| | - Liulin Xiong
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University Applied Lithotripsy Institute, Beijing, China
| | - Lizhe An
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University Applied Lithotripsy Institute, Beijing, China
| | - Kai Ma
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University Applied Lithotripsy Institute, Beijing, China
| | - Mingrui Xia
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University Applied Lithotripsy Institute, Beijing, China
| | - Xiaobo Huang
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University Applied Lithotripsy Institute, Beijing, China
| | - Qingquan Xu
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University Applied Lithotripsy Institute, Beijing, China
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Gao X, Fang Z, Lu C, Shen R, Dong H, Sun Y. Management of staghorn stones in special situations. Asian J Urol 2020; 7:130-138. [PMID: 32257806 PMCID: PMC7096693 DOI: 10.1016/j.ajur.2019.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/05/2019] [Accepted: 10/18/2019] [Indexed: 12/17/2022] Open
Abstract
Staghorn stones have always been a challenge for urologists, especially in some special situations, such as horseshoe kidney, ectopic kidney, paediatric kidney, and solitary kidney. The treatment of these staghorn stones must be aggressive because they can lead to renal function loss and serious complications. The gold-standard management for staghorn stones is surgical treatment with the aim of clearing the stones and preserving renal function. Treatment methods for staghorn stones have developed rapidly, such as extracorporeal shock wave lithotripsy, retrograde intrarenal surgery, percutaneous nephrolithotomy and laparoscopy and open surgery. Whether the standard procedures for staghorn stones can also apply to these stones in special situations is still not agreed upon. The decision should be made individually according to the circumstances of the patient. In this review, we evaluates the previous studies and comments on the management of staghorn stones under special situations in the hope of guiding the optimal choice for urologists.
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Affiliation(s)
- Xiaofeng Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ziyu Fang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Chaoyue Lu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Rong Shen
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hao Dong
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
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5
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Gao H, Zhang H, Wang Y, Li K, Du W, Wang X, Wang J. Treatment of Complex Renal Calculi by Digital Flexible Ureterorenoscopy Combined with Single-Tract Super-Mini Percutaneous Nephrolithotomy in Prone Position: A Retrospective Cohort Study. Med Sci Monit 2019; 25:5878-5885. [PMID: 31389405 PMCID: PMC6693367 DOI: 10.12659/msm.915034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Advances in percutaneous nephrolithotomy (PCNL) have resulted in smaller devices that cause less trauma and bleeding, while flexible ureterorenoscopy (f-URS) allows access to any calyces. These methods are often used in isolation, but used in combination they may improve treatment of complex renal calculi. This study assessed the effectiveness and complications of f-URS combined with super-mini-PCNL (SMP) to treat complex renal calculi. Material/Methods A retrospective cohort analysis was made of patients with unilateral complex renal stones treated between March 2013 and December 2016. Patients were grouped according to surgical procedure: SMP (SMP Group), f-URS holmium laser lithotripsy (f-URS Group), and combined SMP and f-URS (Combined Group). The postoperative complications and complete stone-free rate were analyzed and compared among the 3 groups. Results A total of 140 patients with complex renal stones were included: 40 patients in the SMP Group, 55 in the f-URS Group, and 45 in the Combined Group. The complete stone-free rate 3 days after the procedure was 77.5% in the SMP Group, 78.2% in the f-URS Group, and 97.8% in the Combined Group (p=0.010). The operation time, intraoperative blood loss, and hospitalization time of the Combined Group were all significantly lower than those in the SMP Group but higher than those in the f-URS Group. The follow-up was 9 months (range, 6–12 months). There were no medium-term complications reported. Conclusions SMP combined with f-URS holmium laser lithotripsy in the prone position is an effective treatment for complex renal calculi.
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Affiliation(s)
- Huayu Gao
- Shandong University, Jinan, Shandong, China (mainland).,Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China (mainland)
| | - Hui Zhang
- Shandong University, Jinan, Shandong, China (mainland).,Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China (mainland)
| | - Yunchao Wang
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China (mainland)
| | - Kai Li
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China (mainland)
| | - Wenzhi Du
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China (mainland).,Taishan Medical University, Taian, Shandong, China (mainland)
| | - Xiangyu Wang
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China (mainland).,Taishan Medical University, Taian, Shandong, China (mainland)
| | - Jianning Wang
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China (mainland)
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Garg G, Aggarwal A, Singh M, Sankhwar S, Sharma D, Pandey S. Comparison of efficacy and safety of ESWL in paediatric and adolescent versus adult urolithiasis: A single center 5-year experience from a tertiary care hospital. AFRICAN JOURNAL OF UROLOGY 2018. [DOI: 10.1016/j.afju.2018.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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7
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Sharifiaghdas F, Tabibi A, Nouralizadeh A, Sotoudeh M, Ayanifard M, Pakmanesh H, Soltani MH. Our Experience with Totally Ultrasonography-Guided Percutaneous Nephrolithotomy in Children. J Endourol 2015; 35:749-752. [PMID: 26058433 DOI: 10.1089/end.2014.0660] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To present the safety and efficacy of totally ultrasonography-guided percutaneous nephrolithotomy (PCNL) for managing urinary stones in pediatric patients. Patients and Methods: Ten children with a mean age of 5.4 (3-11) years underwent totally ultrasonography-guided PCNL from March 2013 to November 2013. The pyelocaliceal system was punctured with the patient in the prone position by using ultrasonographic guidance, and the tract was dilated using a single-shot dilation technique. All steps of renal access were performed by using ultrasonography; no fluoroscopy was used. PCNL in all cases was performed by using adult instruments. Results: The mean stone size was 28.9±6.7 mm (range 17-35 mm). The mean access time to stone was 4.45±2.25 minutes (range 3-10 min). The mean nephroscopic time was 45.9±17 minutes (range 20-80 min). The stone-free rate was 83%. Mean hospital stay of patients was 3 days (range 2-5 days). No major complications were happened. Only one patient needed ureteral stent insertion because of urinary leakage from the nephrostomy tract. Conclusion: 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.
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Affiliation(s)
- Farzaneh Sharifiaghdas
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran
| | - Ali Tabibi
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran
| | - Akbar Nouralizadeh
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran
| | - Mehdi Sotoudeh
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran
| | - Mohammad Ayanifard
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran
| | - Hamid Pakmanesh
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran
| | - Mohammad Hossein Soltani
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran
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8
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Rodríguez D, Sacco DE. Minimally invasive surgical treatment for kidney stone disease. Adv Chronic Kidney Dis 2015; 22:266-72. [PMID: 26088070 DOI: 10.1053/j.ackd.2015.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/11/2015] [Accepted: 03/11/2015] [Indexed: 12/23/2022]
Abstract
Minimally invasive interventions for stone disease in the United States are mainly founded on 3 surgical procedures: extracorporeal shock wave lithotripsy, ureteroscopic lithotripsy, and percutaneous nephrolithotomy. With the advancement of technology, treatment has shifted toward less invasive strategies and away from open or laparoscopic surgery. The treatment chosen for a patient with stones is based on the stone and patient characteristics. Each of the minimally invasive techniques uses an imaging source, either fluoroscopy or ultrasound, to localize the stone and an energy source to fragment the stone. Extracorporeal shock wave lithotripsy uses a shock wave energy source generated outside the body to fragment the stone. In contrast, with ureteroscopy, laser energy is placed directly on the stone using a ureteroscope that visualizes the stone. Percutaneous nephrolithotomy requires dilation of a tract through the back into the renal pelvis so that instruments can be inserted directly onto the stone to fragment or pulverize it. The success of the surgical intervention relies on performing the least invasive technique with the highest success of stone removal.
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9
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10
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Gamal W, Moursy E, Hussein M, Mmdouh A, Hammady A, Aldahshoury M. Supine pediatric percutaneous nephrolithotomy (PCNL). J Pediatr Urol 2015; 11:78.e1-5. [PMID: 25819602 DOI: 10.1016/j.jpurol.2014.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 10/12/2014] [Indexed: 10/23/2022]
Abstract
INTRODUCTION/BACKGROUND Many authors reported their experience with supine PCNL in adult population comparing the outcome with prone PCNL and they found that the stone free rate and the operative time were in favor of prone PCNL with a lower patient morbidity among patients with supine PCNL. This encouraged us to perform supine PCNL in pediatric population. AN OBJECTIVE In this study we evaluated the safety and efficacy of supine PCNL in pediatric population. STUDY DESIGN (SUBJECTS/PATIENTS/MATERIALS/METHODS) Between April 2011 and February 2014 a total of 27 children (6 girls and 21 boys) presented with renal calculi. The stones were single pelvic stone in 14 cases, pelvic stone with lower calyceal stones in 7 cases and pelvic stone with upper calyceal stones in 6 cases. The mean stone size was 32 mm (range 20-47 mm). All patients were managed with supine PCNL performed by a single surgeon. Marking the posterior axillary line in standing position before the operation is a mandatory initial step. The patients were placed in supine position with elevation of the ipsilateral shoulder and hip by means of two bags one underneath the shoulder and the other underneath the hip to widen the operative field. The technique was performed using a sheathless 19 fr. Richard wolf rigid nephroscope after acute tract dilation by amplatz dilators. Complications (intraoperative and postoperative) and stone free rate rates were reported. RESULTS A single lower calyceal access was used in all cases through which we could successfully remove even the upper calyceal stones. Kinking of the guide wire during tract dilatation were encountered in 4 cases and the guide wire was successfully exchanged using a small Teflon dilator in 2 cases while ultrasonographic guided lower calyceal repuncture was done in 2 cases. The average operative time (from the beginning of the puncture trial to nephrostomy tube insertion) was (41 ± 15) min. The operation was successfully completed as planned in all cases with two cases of intraoperative complications (one case of pelvicalyceal system perforation and another case of intraoperative bleeding and blood transfusion). The initial stone free rate was (92.5%). Postoperative complications was reported in the form of 2 cases of fever that respond to medical treatment for 72 h. DISCUSSION The main advantages of supine pediatric PCNL is that it is comfortable for the surgeon, the anesthetist and the child. The main disadvantages of supine pediatric PCNL is that it is not familiar for most urologists and small field of operation. The short outcome of our study is the small number of cases and the lack of comparative study with prone pediatric PCNL. CONCLUSIONS Pediatric supine PCNL is a safe and effective method for management of pediatric renal stones. It carries the advantages of easily upper calyx access through the lower calyceal tract, low incidence of fluid absorption or hypothermia and easy anesthesia monitoring. However a larger number of cases are needed to be evaluated.
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Affiliation(s)
- W Gamal
- Department of Urology, Sohag University, Egypt.
| | - E Moursy
- Department of Urology, Sohag University, Egypt
| | - M Hussein
- Department of Urology, Sohag University, Egypt
| | - A Mmdouh
- Department of Urology, Sohag University, Egypt
| | - A Hammady
- Department of Urology, Sohag University, Egypt
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11
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Buldu I, Tepeler A, Karatag T, Bodakci MN, Hatipoglu NK, Penbegul N, Akman T, Istanbulluoglu O, Armagan A. Does aging affect the outcome of percutaneous nephrolithotomy? Urolithiasis 2014; 43:183-7. [PMID: 25395249 DOI: 10.1007/s00240-014-0742-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/04/2014] [Indexed: 11/28/2022]
Abstract
To investigate whether aging affects surgical outcomes by comparing the results of two patient groups undergoing PNL: those over 60 and those under 60. A retrospective screen was made for patients undergoing conventional PNL surgery for renal stones performed in two separate centers between 2010 and 2013. 520 patients included were classified into age groups: patients aged 18-59 comprised Group-1 and those aged over 60 comprised Group-2. Those between 60-69 years (sexagenarian) were assigned to Group-2a; 70-79 years (septuagenarian) to Group-2b; and 80-89 years (octogenarian) to Group-2c. Patients' demographic characteristics (accompanying comorbidities, ASA scores, body mass indices and stone size) and perioperative values (duration of surgery and hospital stay, success and complication rates) were compared between the groups. Mean stone size was similar in groups (30.1 ± 15.5 vs. 31.5 ± 15.4 mm, p = 0.379). The mean ASA value for the patients in Group-1 was 1.61; significantly lower than that in the other groups (p = 0.000). The level of accompanying comorbidities in Group-1 was significantly lower than that of the other groups (p = 0.000). The mean duration of surgery, postoperative hematocrit drop, complication and success rate were statistically similar in Groups 1 and 2 (p = 0.860, p = 0.430, p = 0.7, and p = 0.66, respectively). The duration of hospital stay was significantly shorter in the patients in Group-1 compared to those in Group-2 (p = 0.008). In experienced hands, PNL can be safely and reliably performed in the treatment of renal stones in elderly patients.
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Affiliation(s)
- Ibrahım Buldu
- Department of Urology, School of Medicine, University of Mevlana, Konya, Turkey,
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12
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Goyal NK, Goel A, Sankhwar SN, Singh V, Singh BP, Sinha RJ, Dalela D, Yadav R. A critical appraisal of complications of percutaneous nephrolithotomy in paediatric patients using adult instruments. BJU Int 2014; 113:801-10. [DOI: 10.1111/bju.12506] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Neeraj Kumar Goyal
- Department of Urology; King George's Medical University (Formerly, Chhatrapati Shahuji Maharaj Medical University); Lucknow India
| | - Apul Goel
- Department of Urology; King George's Medical University (Formerly, Chhatrapati Shahuji Maharaj Medical University); Lucknow India
| | - Satya Narayan Sankhwar
- Department of Urology; King George's Medical University (Formerly, Chhatrapati Shahuji Maharaj Medical University); Lucknow India
| | - Vishwajeet Singh
- Department of Urology; King George's Medical University (Formerly, Chhatrapati Shahuji Maharaj Medical University); Lucknow India
| | - Bhupendra Pal Singh
- Department of Urology; King George's Medical University (Formerly, Chhatrapati Shahuji Maharaj Medical University); Lucknow India
| | - Rahul Janak Sinha
- Department of Urology; King George's Medical University (Formerly, Chhatrapati Shahuji Maharaj Medical University); Lucknow India
| | - Divakar Dalela
- Department of Urology; King George's Medical University (Formerly, Chhatrapati Shahuji Maharaj Medical University); Lucknow India
| | - Rahul Yadav
- Department of Urology; King George's Medical University (Formerly, Chhatrapati Shahuji Maharaj Medical University); Lucknow India
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Jee JY, Kim SD, Cho WY. Efficacy of extracorporeal shock wave lithotripsy in pediatric and adolescent urolithiasis. Korean J Urol 2013; 54:865-9. [PMID: 24363869 PMCID: PMC3866291 DOI: 10.4111/kju.2013.54.12.865] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/23/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To retrospectively evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) by age and current condition as a first-line treatment for pediatric and adolescent urolithiasis. MATERIALS AND METHODS The computerized records of 55 children were retrospectively reviewed from March 1991 to July 2007. The children were below 18 years of age and had undergone ESWL monotherapy for urolithiasis. There were 36 boys (65.5%) and 19 girls (34.5%), with a mean age of 8.5 years (range, 0.5-18 years). There were 24 patients aged 7 years or less and 31 patients aged more than 7 years. RESULTS The mean size of the stones was 9.48 mm (range, 4-22 mm). The overall success rate of ESWL was 90.9% (50 children). The mean number of ESWL sessions was 2.02 (range, 1-10). The mean number of ESWL sessions for the patient group aged 7 years or less was 1.16 (range, 1-2) and that for the patient group aged more than 7 years was 2.97 (range, 1-10; p=0.037). There was also a statistically significant difference in the mean number of ESWL sessions between the younger and older patients who needed general anesthesia (1.16 vs. 2.2 sessions, respectively; 0.042). CONCLUSIONS In the patient group aged 7 years or less, the number of ESWL sessions and the complication rate were comparable with those for endoscopic management. Thus, ESWL is an effective first-line treatment modality for patients aged less than 7 years.
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Affiliation(s)
- Joon Yeop Jee
- Department of Urology, Dong-A University College of Medicine, Busan, Korea
| | - Soo Dong Kim
- Department of Urology, Dong-A University College of Medicine, Busan, Korea
| | - Won Yeol Cho
- Department of Urology, Dong-A University College of Medicine, Busan, Korea
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14
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Nouralizadeh A, Lashay A, Ziaee SAM, Ahanian A, Sharifi SHH, Nikkar MM, Ojand A, Soltani MH. Percutaneous nephrolithotomy in high-risk patients: a single-center experience with more than 350 cases. Urol Int 2013; 90:394-8. [PMID: 23594973 DOI: 10.1159/000347032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 12/24/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the surgical outcomes and peri- and postoperative complications following percutaneous nephrolithotomy (PCNL) in high- and low-risk patients according to the American Society of Anesthesiologists (ASA) score. MATERIALS AND METHODS We reviewed the patient records of 2,281 cases older than 18 years who had undergone PCNL in the 3 previous years. The patients were divided into two groups: a low-risk group (ASA score 1, 2: 1,922 cases) and a high-risk group (ASA score 3, 4: 359 cases). RESULTS Analysis of the location and size of the stone, number and type of access, surgical approach, post-PCNL serum hemoglobin and decrease in glomerular filtration rate revealed no significant difference between the two groups. The stone-free rate was similar in both groups and the hospital stay in the high-risk patients was significantly greater than in the low-risk cases. 95% of low-risk and 91% of high-risk cases had surgical complications compatible with grade ≤II (Clavien system) and overall distribution of different grades of surgical complications was similar between the two groups (p = 0.177). CONCLUSION Success rate and surgical complications of PCNL in high-risk patients were comparable to low-risk patients. It seems that PCNL may be a safe and effective procedure even in high-risk patients.
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Affiliation(s)
- Akbar Nouralizadeh
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
PURPOSE We report our initial experience of MINI percutaneous nephrolithotomy (PCNL) in a pediatric population using a miniature nephroscope through a 16F metal access sheath. METHODS All pediatric patients who underwent PCNL from August 2007 to September 2010 using a 14F miniature nephroscope through a 16F metal access sheath for renal stone extraction were evaluated. Patients' demographic details, procedural information, and posttreatment outcomes were prospectively documented. RESULTS A total of 23 MINI PCNLs were performed on 23 kidneys of 12 patients whose ages ranged from 1.6 to 14.6 years. The median stone burden was 3.44 cm(2), and there were 11 "Staghorn" stones. The procedure was primary via a single puncture in 19 kidneys and secondary using a preexisting nephrostomy tract in 4 kidneys. Access was successful in all primary and two secondary cases, for a total of success rate of 91.3 %. Stones were fragmented using a Holmium laser and/or lithoclast, and fragments were irrigated or sequentially removed by various stone grasping devices. The mean procedural X-ray screening time and total stone extraction period were 4.5 and 109.4 min, respectively. The primary stone free rate was 83.6 %, which increased to 90.5 % after treating the residual fragments. Postoperative hydrothorax developed in one patient, which required a chest drain. Symptoms of chest infection and positive urine culture were detected in one and two patients, respectively. CONCLUSIONS Our initial experience supports previous reports that MINI PCNL is safe and effective for the management of renal stones in children.
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16
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Percutaneous nephrolithotomy in infants: evaluation of a single-center experience. Urology 2012; 80:408-11. [PMID: 22743259 DOI: 10.1016/j.urology.2012.04.058] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 04/25/2012] [Accepted: 04/30/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) in infants (<3 years) with renal calculi. METHODS From November 2005 to August 2010, 20 renal units with calculi in 19 infants (13 boys and 6 girls) were treated with PCNL at our institution. Mean age of infants was 20.6 months (range, 7-36 months), the mean stone size was 2.2 cm (range, 1.9-3.1 cm). All PCNL procedures were performed with 14 to 16F percutaneous access and 8/9.8F rigid ureteroscope. Stones were fragmented with a pneumatic lithotripter and evacuated. RESULTS Mean operative time was 77.5 minutes (range, 35-120 minutes). Stones were completely removed in 85% of kidneys (17 of 20 kidneys) after the first session and 95% (19 of 20 kidneys) after a second look PCNL procedure. No patients required a blood transfusion. Evaluation of the renal function before and after the PCNL procedure demonstrated the stabilization of corresponding glomerular filtration rate in the treated kidney (48.2 ± 3.7 vs 50.4 ± 5.2 mL/min; P = .22). CONCLUSION When performed by experienced endourologists, PCNL is a safe and effective procedure in infants for the removal of renal calculi.
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17
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Yucel S, Akin Y, Danisman A, Guntekin E. Complications and Associated Factors of Pediatric Extracorporeal Shock Wave Lithotripsy. J Urol 2012; 187:1812-6. [DOI: 10.1016/j.juro.2011.12.092] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Indexed: 10/28/2022]
Affiliation(s)
- Selcuk Yucel
- Department of Urology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Yigit Akin
- Department of Urology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ahmet Danisman
- Department of Urology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Erol Guntekin
- Department of Urology, Akdeniz University School of Medicine, Antalya, Turkey
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18
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Jessen JP, Knoll T. Management of Cystinuria. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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19
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Zaidi Z, Alam Z. Endourological Approaches to Renal and Ureteric Calculi in Children. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Abstract
Pediatric urolithiasis is a management dilemma as a number of treatment options are available such as shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS). PCNL offers good clearance rates in a single hospital stay. The concerns with PCNL include the use of large instrument in pediatric kidneys, parenchymal damage and the associated effects on renal function, radiation exposure with fluoroscopy, and the risk of major complications including sepsis and bleeding. Evolution of pediatric PCNL technique such as miniaturization of instruments, limitation of tract size and advanced intracorporeal lithotripters have resulted in this technique being widely utilized for achieving stone-free status in appropriate patients. Many of the patients in our country come from remote areas thereby requiring special considerations during treatment. This also necessitates complete clearance in a single shorter hospital stay. PCNL appears to be the optimal option available in this scenario. The literature suggests that even complex and staghorn calculi can be tackled with this approach. The choice of the method to gain access is a matter of experience and personal preference. Ultrasound offers the advantage of visualization of spleen, liver and avoids injury. Miniaturization of instruments, particularly smaller nephroscopes and the potential to use lasers will decrease the morbidity and improve the clearance rates further. In this article, we analyze the management of pediatric urolithiasis with PCNL. We discuss our technique and analyze the results, complications and technique mentioned in the contemporary literature.
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Affiliation(s)
- Arvind P Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat-387 001, India
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21
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Abstract
PURPOSE OF REVIEW The management of urolithiasis in children has significantly changed over the past 20 years. Extracorporeal shockwave lithotripsy (SWL) was initially the preferred modality of treatment. More recently, ureteroscopy and percutaneous nephrolithotomy (PCNL) are being used at an increasing frequency in the management of pediatric stone disease. RECENT FINDINGS Development has been made in various aspects of pediatric endoscopic stone management. Ureteroscopy and PCNL have been applied at an increasing frequency to treat pediatric stone disease, which has guided modifications to improve the procedures. Increased endoscopic experience with managing urolithiasis has broadened the indications wherein these methods are utilized. Technology is continually advancing to meet the needs of this population. Ureteroscopes have been modified to accommodate the pediatric ureter, optics advanced, and access sheaths are used to improve results. In addition, technique is constantly being refined. SUMMARY Further experience will direct surgeons as to when ureteroscopy and PCNL are appropriate. The incidence of urolithiasis is on the rise in developing nations; there is a need to address the most efficient method of treatment that minimizes the morbidity to the child.
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22
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Desai MR, Sharma R, Mishra S, Sabnis RB, Stief C, Bader M. Single-step percutaneous nephrolithotomy (microperc): the initial clinical report. J Urol 2011; 186:140-5. [PMID: 21575966 DOI: 10.1016/j.juro.2011.03.029] [Citation(s) in RCA: 175] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Indexed: 12/17/2022]
Abstract
PURPOSE To our knowledge we report the first technical feasibility and safety study of 1-step percutaneous nephrolithotomy using the previously described 4.85Fr all-seeing needle (PolyDiagnost, Pfaffenhofen, Germany). We defined microperc as modified percutaneous nephrolithotomy in which renal access and percutaneous nephrolithotomy are done in 1 step using the all-seeing needle. MATERIALS AND METHODS Microperc was performed in 10 cases using the 4.85Fr all-seeing needle to achieve collecting system access under direct vision. Percutaneous nephrolithotomy was done through the same 16 gauge needle sheath with a 3-way connector allowing irrigation, and passage of a flexible telescope and a 200 μm holmium:YAG laser fiber. We prospectively analyzed preoperative, intraoperative and postoperative parameters. RESULTS Mean calculous size was 14.3 mm. Two of the 10 patients were of pediatric age, and 1 each had an ectopic pelvic kidney, chronic kidney disease and obesity. Microperc was feasible in all cases with mean ± SD surgeon visual analog score for access of 3.1 ± 1.2, a mean 1.4 ± 1.0 gm/dl hemoglobin decrease and a mean hospital stay of 2.3 ± 1.2 days. The stone-free rate at 1 month was 88.9%. In 1 patient intraoperative bleeding obscured vision, requiring conversion to mini percutaneous nephrolithotomy. There were no postoperative complications and no auxiliary procedures were required. CONCLUSIONS Microperc is technically feasible, safe and efficacious for small volume renal calculous disease. Further clinical studies and direct comparison with available modalities are required to define the place of microperc in the treatment of nonbulky renal urolithiasis.
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Affiliation(s)
- Mahesh R Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Gujarat, India.
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23
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Guven S, Istanbulluoglu O, Gul U, Ozturk A, Celik H, Aygün C, Ozdemir U, Ozturk B, Ozkardes H, Kilinc M. Successful Percutaneous Nephrolithotomy in Children: Multicenter Study on Current Status of its Use, Efficacy and Complications Using Clavien Classification. J Urol 2011; 185:1419-24. [PMID: 21334653 DOI: 10.1016/j.juro.2010.11.055] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Selcuk Guven
- Department of Urology, Selcuk University Meram Medical School, Konya Hospital, Turkey
| | - Okan Istanbulluoglu
- Department of Urology, Baskent University Medical School, Konya Hospital, Turkey
| | - Umit Gul
- Department of Urology, Adana Hospital, Turkey
| | - Ahmet Ozturk
- Department of Urology, Selcuk University Meram Medical School, Konya Hospital, Turkey
| | | | - Cem Aygün
- Department of Urology, Ankara Hospital, Turkey
| | - Umit Ozdemir
- Department of Urology, Selcuk University Meram Medical School, Konya Hospital, Turkey
| | - Bulent Ozturk
- Department of Urology, Baskent University Medical School, Konya Hospital, Turkey
| | | | - Mehmet Kilinc
- Department of Urology, Selcuk University Meram Medical School, Konya Hospital, Turkey
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24
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Current world literature. Curr Opin Urol 2011; 21:166-72. [PMID: 21285721 DOI: 10.1097/mou.0b013e328344100a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Ozturk A, Guven S, Kilinc M, Topbaş E, Piskin M, Arslan M. Totally Tubeless Percutaneous Nephrolithotomy: Is It Safe and Effective in Preschool Children? J Endourol 2010; 24:1935-9. [DOI: 10.1089/end.2010.0100] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ahmet Ozturk
- Department of Urology, Selcuk University Meram Medical School, Akyokus Konya, Turkey
| | - Selcuk Guven
- Department of Urology, Selcuk University Meram Medical School, Akyokus Konya, Turkey
| | - Mehmet Kilinc
- Department of Urology, Selcuk University Meram Medical School, Akyokus Konya, Turkey
| | - Emrah Topbaş
- Department of Urology, Selcuk University Meram Medical School, Akyokus Konya, Turkey
| | - Mesut Piskin
- Department of Urology, Selcuk University Meram Medical School, Akyokus Konya, Turkey
| | - Mehmet Arslan
- Department of Urology, Selcuk University Meram Medical School, Akyokus Konya, Turkey
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26
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Abstract
Surgical management of urinary stones in children remains challenging due to the smaller caliber of the urinary tract. Specific instruments have been designed to overcome some of the issues related to pediatric stone management. Endoscopic and percutaneous modalities for stone management have been shown to be as safe and effective in providing stone clearance in children as in adults. Technologies that have been shown to be safe in adults are being miniaturized for use in children. The current literature regarding pediatric urolithiasis was reviewed in an effort to identify trends in operative management. Additionally, techniques used successfully at our institution are described. Although not an exhaustive review of all available modalities and instruments, this review will provide an overview of the current techniques for the management of pediatric urolithiasis.
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Affiliation(s)
- Jiakai Zhu
- Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, USA
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27
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Ozturk A, Guven S, Piskin M, Kilinc M, Celik J, Arslan M. Management of multiple stones in a single session using minimally invasive methods in infants with renal failure: renal salvage. Int Urol Nephrol 2010; 44:3-6. [PMID: 20848198 DOI: 10.1007/s11255-010-9832-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 08/24/2010] [Indexed: 10/19/2022]
Abstract
The goal in the treatment of stone disease causing infantile obstructive uropathy is to obtain a quick resolution of the obstruction using the least invasive treatment modality available and rendering the patient stone-free, if possible. Two infants with bilateral kidney stones, the first of whom also had ureteral stone, were referred to our clinic with acute renal failure and were treated successfully in a single session using minimally invasive methods. In this report, we discuss the management of these two cases, aged 9 and 26 months, which resulted in favorable outcomes.
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Affiliation(s)
- Ahmet Ozturk
- Department of Urology, Selcuk University Meram Medical School, 42080 Akyokus, Konya, Turkey
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28
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Bibliography: Current world literature. Female urology. Curr Opin Urol 2010; 20:343-6. [PMID: 20531093 DOI: 10.1097/mou.0b013e32833bd73a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Status quo of percutaneous nephrolithotomy in children. ACTA ACUST UNITED AC 2010; 38:1-5. [PMID: 19921165 DOI: 10.1007/s00240-009-0240-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 11/04/2009] [Indexed: 12/26/2022]
Abstract
Paediatric nephrolithiasis is quite challenging in terms of management because of the smaller size of the urinary tract and the bigger risk for stone recurrence. Children bear a higher risk of metabolic and infectious causes of stone disease and a longer lifetime risk for recurrence, especially in cases of residual fragments. Complete stone clearance should become the absolute objective and clinically insignificant residual fragments should be avoided. Nowadays, percutaneous nephrolithotomy (PCNL) arises as a logical first-line treatment option for considerable paediatric nephrolithiasis as miniaturization of endoscopes and advances in energy sources for stone fragmentation have facilitated stone-free rates. In this review we present the evolution of PCNL in children and we demonstrate its safety and efficacy. As appropriate instruments are available and relevant surgical experience is accumulating, age should no longer exist as a limiting factor for performing PCNL.
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