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

• Published in: Urology (Ridgewood, N.J.) Vol. 86; no. 5; pp. 1019 - 1026
• Main Authors: Daw, Kareem, Shouman, Ahmed M., Elsheemy, Mohammed S., Shoukry, Ahmed I., Aboulela, Waseem, Morsi, Hany A., Badawy, Hesham, Eissa, Mohamed A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2015
• Subjects: Age Factors; Chi-Square Distribution; Child, Preschool; Cohort Studies; Female; Follow-Up Studies; Humans; Infant; Kidney Calculi - diagnostic imaging; Kidney Calculi - surgery; Lithotripsy - methods; Male; Minimally Invasive Surgical Procedures; Nephrostomy, Percutaneous - methods; Operative Time; Patient Safety; Prospective Studies; Treatment Outcome; Ultrasonography, Doppler; Urology
• ISSN: 0090-4295; 1527-9995; 1527-9995
• DOI: 10.1016/j.urology.2015.08.019

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. 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. 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). 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.