Outcome of Mini-percutaneous Nephrolithotomy for Renal Stones in Infants and Preschool Children: A Prospective Study

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• 作者：Kareem Daw ; Ahmed M. Shouman ; Mohammed S. Elsheemy ; ^{mohammedshemy@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; Ahmed I. Shoukry ; Waseem Aboulela ; Hany A. Morsi ; Hesham Badawy ; Mohamed A. Eissa
• 刊名：Urology
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：86
• 期：5
• 页码：1019-1026
• 全文大小：170 K

文摘

To assess the safety and efficacy of Miniperc for renal stones in preschool-age patients. To the best of our knowledge, this may be the first prospective study on this subject. Reports on Miniperc are still few and mostly retrospective using a sheath size of ≥18Fr, which is still relatively large for young children.

Patients and Methods

From January 2012 to May 2013, Miniperc was performed for 26 children (≤6 years old) with renal calculi <5 cm through 14Fr sheath using a 9.5Fr semirigid ureteroscope with Holmium:yttrium-aluminum-garnet laser lithotripsy. Effects of different factors on operative time, complications, and stone-free rate (SFR) were compared using chi-square, Fischer exact, or Mann-Whitney tests as appropriate using SPSS v15.0.

Results

Primary SFR, SFR after retreatment, and SFR after auxiliary extracorporeal shock wave lithotripsy (ESWL) were 77%, 85%, and 92%, respectively. Retreatment rate was 8%. Auxiliary ESWL was done in 11%. Complications were bleeding (8%), hematuria and blood transfusion (4%), renal pelvis perforation (4%), leakage (8%), and fever (15%). Operative time was significantly prolonged in multiple (>2) stones (P = .006), calyceal stones (P = .002), or stone size ≥30 mm (P = .022). SFR was significantly lower in children with >2 stones (P = .028) and increased stone size ≥30 mm (P = .014).

Conclusion

Miniperc is a safe and effective minimally invasive procedure for pediatric renal stones using 14Fr access sheath. SFR was significantly lower in children with >2 stones or increased stone size ≥30 mm. This was overcome by retreatment and auxiliary ESWL.