Ultramini nephrostomy tract combined with flexible ureterorenoscopy for the treatment of multiple renal calculi in paediatric patients

Abstract

PurposeTo assess the safety and efficacy of an ultramini nephrostomy tract, which we were using for the first time, combined with flexible ureterorenoscopy (URS) in the treatment of pediatric patients with multiple renal calculi.Materials and MethodsTwenty pediatric patients (age, ≤6 years) underwent ultramini percutaneous nephrolithotomy (PCNL) combined with flexible URS. The group had multiple renal calculi, which were bilateral in 3 cases and were located in a total of 23 sites. The calculi were located in 2 calyces in 10 cases, scattered in more than 2 calyces in 7 cases, and limited to 1 calyx in 3 cases. The average patient age was 37.35 months (range, 14-68 months). The average stone diameter was 2.0 cm (range, 1-3.0 cm). In all patients, an ultramini nephrostomy tract was established under ultrasound guidance (dilated to F10) with simultaneous sheath placement. The flexible URS was placed into the collecting system during holmium laser lithotripsy.ResultsWhen ultramini PCNL was combined with flexible ureterorenoscopic holmium laser lithotripsy, the complete stone-free rate was 87% (20/23). The average level of hemoglobin decreased to 1.0 g/dL after the operation. No blood transfusions were needed. Levels of blood urea nitrogen, creatinine, and C-reactive protein were not significantly different before and after the operation. The average duration of hospitalization was approximately 4.85 days, and all cases were followed up for 6 to 12 months. No complications were found.ConclusionsUltramini PCNL combined with flexible ureterorenoscopic holmium laser lithotripsy is a safe and effective treatment for children with multiple renal calculi.

Treatment of Complex Renal Calculi by Digital Flexible Ureterorenoscopy Combined with Single-Tract Super-Mini Percutaneous Nephrolithotomy in Prone Position: A Retrospective Cohort Study

“…In addition, in the complete prone position, the patient’s ureter moves under the action of gravity, and there is no obvious abnormality in the position of the ureter compared with the position of lithotomy, which is conducive to performance of ureteroscopy. The second advantage is that the combined surgical method can effectively remove stones from the super-renal and subrenal calyx, which avoids the disadvantages of either single procedure [17]. In the combined operation method, the flexible ureteroscope is located in a natural orifice, which can avoid smaller stone particles resulting from stone pulverization entering the ureter for formation of a “stone street”, and it reduces related complications.…”

“…During the establishment of the nephroscope channel, the ureteroscope allows real-time observation, which, combined with B-ultrasound guidance, ensures a precise puncture, avoids damaging large blood vessels, and improves the safety of surgery. In addition, the placement of a double J tube and renal fistula tube can be visualized to ensure they are placed in the optimal position [17]. However, the combined method has some disadvantages; combined SMP and f-URS surgery requires a high level of skill because the operator must have both percutaneous nephroscopy and flexible ureteroscope surgery experience, more personnel are needed as a double-mirror combined surgery usually needs 2 groups of surgeons, and there is a longer learning curve for the operator.…”

“…These rates are similar to other studies that have used combined methods in treating multiple kidney stones. In pediatric patients, this achieved a stone-free rate of 87% in these difficult-to-treat cases because of the small size of the calyx [17], and in adult patients there was a 92% stone-free rate compared to 80% in patients treated with flexible URS alone [18]. Large stones treated in adults achieved a 81.7% stone-free rate versus 38.9% for mini-PCNL alone [19]; however, the stone-free rates for staghorn stones were similarly high, above 85%, for patients treated with PCNL alone and PCNL and flexible URS in combination, and the combination treatment was longer, with a longer hospitalization time, but this method used traditional PCNL [20].…”

“…However, these techniques cannot resolve all cases with multiple kidney stones, resulting in a low stone-free rate and complications in some patients [12,14]. Previous reports have demonstrated that miniaturized PCNL combined with digital flexible URS is safe for pediatric [17] and adult patients [18] with multiple kidney stones and for adults with large stones [19,20]. The combination of SMP and flexible URS means the entire procedure from puncture to PCNL can be constantly monitored and limits the size and number of tracts during PCNL.…”

“…The combination of SMP and flexible URS means the entire procedure from puncture to PCNL can be constantly monitored and limits the size and number of tracts during PCNL. However, there have been few studies on the use of miniaturized PCNL combined with flexible URS in the treatment of large stones and multiple kidney stones [17–20]. Further information is needed to support the use of this technique in suitable patient populations.…”