International Journal of Urology (2015) 22, 773--777
doi: 10.1111/iju.12817
Original Article: Clinical Investigation
Ultrasound-guided micropercutaneous nephrolithotomy in pediatric patients with kidney stones Mehmet Nuri Bodakçi, Necmettin Penbegul, Mansur Dağgülli, Onur Dede, Mehmet Mazhar Utangaç, Namık Kemal Hatipoglu and Ahmet Ali Sancaktutar Department of Urology, Dicle University School of Medicine, Diyarbakır, Turkey Abbreviations & Acronyms microperc = micropercutaneous nephrolithotomy PNL = percutaneous nephrolithotomy SWL = shock wave lithotripsy US = ultrasound YAG = yttrium aluminium garnet Correspodence: Mehmet Nuri Bodakçi M.D., Department of Urology, Dicle University School of Medicine, 21280 Diyarbakir, Turkey. Email: [email protected] Received 5 January 2015; accepted 13 April 2015. Online publication 14 May 2015
Objective: To present the outcomes of ultrasound-guided micropercutaneous nephrolithotomy for the treatment of renal stones in pediatric patients. Methods: Ultrasound-guided micropercutaneous nephrolithotomy was carried out on 25 pediatric patients from June 2012 to October 2014. Micropercutaneous nephrolithotomy surgery was completed without the use of fluoroscopy in 19 patients. Medical records were retrieved from our institutional database and retrospectively reviewed. Percutaneous puncture was carried out by an “all-seeing needle” in seven patients and by a 14-G intravenous cannula in 18 patients. After entering to the collecting system through an “all-seeing needle” or by Microsheath, the calculus was fragmented using a 273-micron holmium yttrium aluminium garnet laser. After the stone was fragmented to the smallest pieces possible, the operation was terminated. Results: Single access was obtained in all patients using ultrasound guidance. The average age of the patients was 4.12 ± 5.33 years. The mean stone size was 13.45 ± 3.11 mm. The mean operative time was 51.45 ± 30.69 min. The mean duration of hospitalization was 3.18 ± 1.77 days. Treatment success was 92%. Two patients had residual fragments after the procedure; these patients were followed conservatively. A total of three minor complications were observed and all of them were managed conservatively. Conclusions: To our knowledge, this is the first study of ultrasound-guided micropercutaneous nephrolithotomy in the pediatric population. Our findings suggest that micropercutaneous nephrolithotomy can be safely carried out with ultrasound guidance in children by experienced hands, allowing to minimize risks associated with radiation exposure in this patient population.
Key words:
fluoroscopy, micropercutaneous nephrolithotomy, nephrolithiasis, radiation,
ultrasound.
Introduction PNL is accepted as the standard procedure for the treatment of large renal calculi.1 During a conventional PNL procedure, a 24–30-Fr access tract was used, but as the procedure evolved, this access tract was decreased to
doi: 10.1111/iju.12817
Original Article: Clinical Investigation
Ultrasound-guided micropercutaneous nephrolithotomy in pediatric patients with kidney stones Mehmet Nuri Bodakçi, Necmettin Penbegul, Mansur Dağgülli, Onur Dede, Mehmet Mazhar Utangaç, Namık Kemal Hatipoglu and Ahmet Ali Sancaktutar Department of Urology, Dicle University School of Medicine, Diyarbakır, Turkey Abbreviations & Acronyms microperc = micropercutaneous nephrolithotomy PNL = percutaneous nephrolithotomy SWL = shock wave lithotripsy US = ultrasound YAG = yttrium aluminium garnet Correspodence: Mehmet Nuri Bodakçi M.D., Department of Urology, Dicle University School of Medicine, 21280 Diyarbakir, Turkey. Email: [email protected] Received 5 January 2015; accepted 13 April 2015. Online publication 14 May 2015
Objective: To present the outcomes of ultrasound-guided micropercutaneous nephrolithotomy for the treatment of renal stones in pediatric patients. Methods: Ultrasound-guided micropercutaneous nephrolithotomy was carried out on 25 pediatric patients from June 2012 to October 2014. Micropercutaneous nephrolithotomy surgery was completed without the use of fluoroscopy in 19 patients. Medical records were retrieved from our institutional database and retrospectively reviewed. Percutaneous puncture was carried out by an “all-seeing needle” in seven patients and by a 14-G intravenous cannula in 18 patients. After entering to the collecting system through an “all-seeing needle” or by Microsheath, the calculus was fragmented using a 273-micron holmium yttrium aluminium garnet laser. After the stone was fragmented to the smallest pieces possible, the operation was terminated. Results: Single access was obtained in all patients using ultrasound guidance. The average age of the patients was 4.12 ± 5.33 years. The mean stone size was 13.45 ± 3.11 mm. The mean operative time was 51.45 ± 30.69 min. The mean duration of hospitalization was 3.18 ± 1.77 days. Treatment success was 92%. Two patients had residual fragments after the procedure; these patients were followed conservatively. A total of three minor complications were observed and all of them were managed conservatively. Conclusions: To our knowledge, this is the first study of ultrasound-guided micropercutaneous nephrolithotomy in the pediatric population. Our findings suggest that micropercutaneous nephrolithotomy can be safely carried out with ultrasound guidance in children by experienced hands, allowing to minimize risks associated with radiation exposure in this patient population.
Key words:
fluoroscopy, micropercutaneous nephrolithotomy, nephrolithiasis, radiation,
ultrasound.
Introduction PNL is accepted as the standard procedure for the treatment of large renal calculi.1 During a conventional PNL procedure, a 24–30-Fr access tract was used, but as the procedure evolved, this access tract was decreased to
