Micro-percutaneous nephrolithotomy in the treatment of pediatric nephrolithiasis: A single-center experience

ObjectiveWe aimed to clarify the applicability and safety of micro-PNL (microperc) in the treatment of pediatric kidney stones.Material and methodsA single center prospective trial was initiated, and microperc was performed in 40 children using the same two methods: the classical all-seeing needle and microsheath method. Stone fragmentation was performed using a 200-μm holmium:YAG laser fiber.ResultsThe mean age of the patients was 6.3 ± 4.4 years (range: 7 months–16 years). Fourteen were less than 3 years old. The average calculous size was 16.5 mm (range: 10–36 mm). In 20 patients, access was achieved through the all-seeing needle method. In the other patients, access was achieved by the microsheath method. Conversion to mini-PNL was required in 2 patients due to intraoperative bleeding in one and a high stone burden in the other. The mean hospital stay was 3.8 ± 1.2 days (range: 1–10 days), and the mean hemoglobin decrease was 0.7 ± 0.3 mg/dl (range: 0–1.7 mg/dl).The duration of surgery and fluoroscopic screening was 75 min and 3.7 min, respectively. A DJ stent was placed in 11 patients due to a high stone burden. A ureteral stent was left for 1 day in the rest of the cases. Complete clearance was achieved in the other 32 children. None of the patients required transfusion caused by renal hemorrhage. In 1 patient, extravasation of the irrigation fluid caused abdominal distention. As assessed by KUB and/or an ultrasound, the overall stone-free rate at 6 weeks was 80%. There were residual fragments in 6 patients (15%).ConclusionsOur results show that microperc is a safe and effective procedure for the treatment of pediatric kidney stones. Children with small renal calculi and with nonobstructed collecting systems are suitable for microperc.