Micropercutaneous Nephrolithotomy in the Management of Bilateral Renal Stones in a 7-Month-Old Infant: The Youngest Case in the Literature

Abstract

During infancy, the renal parenchyma and pelvicalyceal system are relatively fragile. Therefore, percutaneous nephrolithotomy for the management of renal stones in this age group is a challenging procedure for urologists. Herein, we present the uneventful management of bilateral renal stones using micropercutaneous nephrolithotomy (microperc) administered to a 7-month-old infant with recurrent urinary tract infections. In this paper, the advantages and disadvantages of the microperc procedure are discussed. As far as we know, our patient is the youngest case in whom the microperc procedure has been performed.

Microperc with Self-Assembled Fr 4.85 Visual Needle and Ureteral Access Sheath

“…Most reports on its use are for moderate size stones (10-20 mm) and lower calyceal stones that are difficult to handle using extracorporeal shock wave lithotripsy (ESWL) or retrograde intrarenal surgery (RIRS). 4,[6][7][8]10,12,13,15,16,20,23,[38][39][40] Microperc is also performed for pediatric renal stones, 1,7,18,20,40 pelvic ectopic kidney stones, 4,7,8,20,40 kidney stones following partial nephrectomy, 21 kidney stones in severe kyphoscoliosis, 14,26 bladder stones, 6 stones in the isthmus of a horseshoe kidney, 7,21 and awkward lower calyceal anatomy. 7,21 The ideal scenario for microperc is a single calyceal stone, pelvic stone, or multiple stones parallel to the percutaneous renal tract so that lithotripsy can be completed with a single tract and multiple punctures avoi ded.…”

“…[5][6][7][8]11,[14][15][16][17] Irrigation fluid may not be actively drained and pressurized irrigation may increase IPP, requiring aspiration through the ureteral catheter during the procedure. 7,8,18 High IPP can cause fluid absorption, intravasation, extravasation, and even renal perforation. 5,8,13,14 Second, similar to extracorporeal shock wave lithotripsy (ESWL) and flexible ureteroscopy, PCNL is a "break and leave" process with stone fragments left to discharge spontaneously after the surgery.…”