Percutaneous nephrolithotomy (PCNL) has undergone extensive modification to reduce complications. One of the recent advances in minimally invasive procedures is the advent of ultra-mini PCNL (UM-PCNL), which provides miniaturized access to the kidney. However, the specific instruments applied in UM-PCNL may not be found in centers with limited resources. This study evaluated the safety, feasibility, results, and short-term complication rates of performing UM-PCNL using a semi-rigid ureteroscope in preschool children.
Between September 2013 and September 2021, a total of 68 patients, including 42 boys and 26 girls with a mean age of 3.2 ± 2.4 years, underwent UM-PCNL with a 4.5French tip ureteroscope instead of an ultra-mini nephroscope in children aged less than 7 years old. The procedure was done under general anesthesia in the prone position. The nephrostomy tract was dilated to 12F. Stones were fragmented using a pneumatic lithotripter. Irrigation was done with normal saline.
The early stone-free rate (SFR) was 91%, and the short-term total SFR was 97%. No statistically significant difference was found in pre-operative and post-operative Hb, BUN, Cr, Na+, and K+. Fever (11 patients) and ileus (5 patients) constituted the majority of complications, and only one patient required a blood transfusion. None of the cases undergoing UM-PCNL with this method required a re-do PCNL.
Our experience shows that with sufficient experience in handling semi-rigid ureteroscopes, urologists practicing in centers with limited resources could perform UM-PCNL with relatively favorable outcomes.
Urology journal. 2024 Jun 12 [Epub ahead of print]
Mohammad Mehdi Hosseini, Ali Eslahi, Fatemeh Masjedi, Sohail Ahmed, Seyed Sajjad Tabei, Mohammad Reza Abedini
Department of Urology, Endourology and Stone Unit, Shiraz University of Medical Sciences, Shiraz, Iran. ., Department of Urology, Endourology and Stone Unit, Shiraz University of Medical Sciences, Shiraz, Iran. ., Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. ., Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran. ., Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States. ., Department of Urology, Endourology and Stone Unit, Shiraz University of Medical Sciences, Shiraz, Iran. .