Mini-percutaneous Nephrolithotomy Under Total Ultrasonography in Patients Aged Less Than 3 Years： A Single-center Initial Experience from China

• Published in: Chinese medical journal 2015-06, Vol.128 (12), p.1596-1600
• Main Authors: Xiao, Bo, Zhang, Xin, Hu, Wei-Guo, Chen, Song, Li, Yu-Hong, Tang, Yu-Zhe, Liu, Yu-Bao, Li, Jian-Xing
• Format: Article
• Language: English
• Subjects: Antibiotics; Care and treatment; Child, Preschool; China; Diagnosis; Female; Health aspects; Hospitals; Humans; Infant; Kidney Calculi - diagnostic imaging; Kidney Calculi - surgery; Kidneys; Lithotripsy; Male; Nephrostomy, Percutaneous - methods; Original; Patients; Pediatrics; Percutaneous nephrostomy; Retrospective Studies; Sepsis; Treatment Outcome; Ultrasonic imaging; Ultrasonography - methods; Ureteral Calculi - diagnostic imaging; Ureteral Calculi - surgery; Urinary stones; Urinary tract diseases; Urinary tract infections; Urine; Urogenital system; Urology; 中国; 北京大学; 多普勒超声; 平均年龄; 患者; 肾结石; 胸腔积液; 血红蛋白浓度
• ISSN: 0366-6999; 2542-5641
• DOI: 10.4103/0366-6999.158312

Background：Urolithiasis in pediatric population is a serious problem with the incidence increased these years.In the management of larger stones （diameters 〉2 cm）,percutaneous nephrolithotomy （PCNL） is considered to be the gold standard.This study aimed to investigate the efficacy and safety of mini-PCNL under total ultrasonography in patients aged 〈3 years.Methods：We reviewed 68 patients （80 renal units） aged 〈3 years between August 2006 and December 2014 in Peking University People＆#39;s Hospital and Beijing Tsinghua Changung Hospital,including 36 renal units with a single stone,6 with staghom stones,14 with upper ureteral stones,and 24 with multiple stones.The mean age of the patients was 24.2 months （range 6-36 months）,and the mean maximum stone diameter was 19.2 mm （range 10-35 mm）.The puncture site selection and tract dilation were guided by Doppler ultrasonography solely.All procedures were performed using 12-16 Fr tracts.Stones were fragrnented using pneumatic lithotripsy and a holmium laser with an 8/9.8 Fr rigid ureteroscope.Results：Fifty-six patients with unilateral stones underwent a single session procedure,and 12 patients with bilateral stones underwent two procedures.The mean time to establish access was 2.8 min （range 1.8-5.0 min）,the mean operative time was 36.5 min （range 20-88 min）,the mean decrease in hemoglobin concentration was 8.9 g/L （2-15 g/L）,and the stone-free rate （SFR） at hospital discharge was 94.0%.The mean postoperative hospital stay was 7.1 days （range 3-13 days）.Postprocedure complications included fever （〉38.5℃） in five patients and reactive pleural effusion in one patient.Blood loss requiring transfusion,sepsis,adjacent organ injury,and kidney loss were not observed.Conclusions：This study indicated that ultrasound-guided mini-PCNL is feasible and safe in patients aged 〈3 years,without major complications or radiation exposure.