Miniature Percutaneous Nephrolithotomy (Miniperc) Experience of Two Centers in Pediatric Stone Disease
Purpose We have analyzed the efficacy and morbidity of miniperc operations in pediatric stone disease. Material and Methods Thirty pediatric age patients (m: 16, f: 14) were treated with percutaneous nephrolithotomy using miniature instruments through a 14 F dilated tract in urology clinics of two centers. Mean patient age was 4.43 (0.58-12) years. Following retrograde placement of 4 F soft ureteral catheters, percutaneous access was established via fluoroscopic guidance in the prone position. A pediatric working cystoscope (9.5 F) was used for nephroscopy. Anterograde flexible scope (7.5 F, 67 cm) was used for possible remaining stones in the ureter or calyces. Holmium laser or pneumatic lithotriptors were used for in situ lithotripsy. The ureteral catheters were left indwelling in all without bleeding otherwise a 14 F nephrostomy catheter was used for diversion. Results Twenty eight renal units were managed through a single access and four needed multiple accesses. Mean operation time was 78.16 minutes (30–180) and mean stone size was 312 mm 2 (75-1380). Two had open surgery previously. One of the two patients having bilateral stones was operated from both kidneys in the same day where as the other was operated on another date. Four needed blood transfusion. Mean postoperative hospitalization time was 4.03 (2–14) days. In 28 of the 32 renal units complete stone clearance has been achieved. Four of the patients with the residual fragments have undergone ESWL and three of them have become stone free. One patient was left with clinically insignificant fragments. Conclusions The smaller instrument sizes in percutaneous nephrolithotomy can give good results in pediatric age group.