Safety and efficacy of ultrasound-guided low-pressure perfusion mini-percutaneous nephrolithotomy in children aged 1–7 years: a retrospective observational study

Qiu, Zhi; Guo, Quanbin; Ablikim, Zakir; Shi, Xu-Wen; Hou, Jiang-Jiang; Chen, Chang; Hasanjan, Mamat; Akbarjan, Mamat; Abdukadir, Anwar

doi:10.1007/s11255-021-02933-4

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…Геморрагические осложнения у детей после мини-ПНЛ встречались у 9 (4,2%) пациентов, что в два раза ниже, чем у детей после стандартной ПНЛ. Данная ситуация демонстрирует меньшую травматизацию структур ЧЛС в ходе выполнения операции по методики мини-ПНЛ за счет применения инструмента меньшего размера и отсутствия необходимости сложных манипуляций в миниатюрной коллекторной системе крупным инструментом с избыточными физическими усилиями для выполнения стандартной ПНЛ [27][28][29][30][31].…”

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Percutaneous nephrolithotripsy in children using miniature instruments.

Vardak,

Arustamov,

Rudin

et al. 2023

ECU

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Introduction. Currently, percutaneous nephrolithotripsy is the main treatment for large and coral-like kidney stones in children. The purpose of the study was to increase the effectiveness of percutaneous nephrolithotripsy (PCNL) in children using miniature-sized instruments. Materials and methods. For the period from 2008 to 2019, 320 children aged 1 to 17 years underwent nephrolithotripsy in the pediatric department of the N. Lopatkin Scientific Research Institute of Urology. Depending on the size of the instruments used, patients were divided into 3 groups. The first group included children who underwent surgery using the Mini-PCNL technique (n-211), the second group included patients operated on using the Ultra-Mini-PCNL method (n-16) and the third group included children whose percutaneous intervention was performed using a standard-sized nephroscope (n-93). The intervention was carried out according to the standard method; all patients underwent cystoscopy, catheterization of the ureter, access formation, lithotripsy, lithoextraction and installation of nephrostomy drainage. Results. In the first group of children studied, complete elimination of clinically significant stones (residual stones smaller than 4 mm) after the initial intervention was achieved in 169 (80.1%) pediatric patients. In the second group, there was 13 (81.2%) children. And in the third group, getting rid of stones was achieved in 73 (78.5%) patients. The average time required to perform surgery in all three study groups was comparable and amounted to 45 (40-125) minutes in the first group, 40 (25-85) minutes in the second, and 50 (40-180) minutes in the third group. The final efficacy of percutaneous nephrolithotripsy in children using instruments of various sizes in the first group was 89.6%, in the second – 93.7% and 88.1% in the third study group. The hospital stay after surgical treatment was: 4 (3-12) days for the first group, 3.5 (3-7) and 4.5 (3-17) days for the second and third groups, respectively. The need for additional interventions after PCNL in pediatric patients was in 69 (32.7%) children in the first group, 4 (25%) in the second and 41 (44.1%) in the third group. Conclusion. The use of mini-PCNL, ultra-mini-PCNL can reduce the duration of surgical intervention by 10% and 20%, the hospital stay after PCNL by 11.2% and 22.3%, the need for additional interventions by 11.4% and 19.1%. Can reduce the total number of complications by 10% and 12.2%, respectively, compared with the use of standard-size instruments. The use of Mini-PCNL in children is indicated in the younger and middle age groups, Ultra-Mini-PCNL is indicated for single stones up to 2 cm or as an additional access in the multi-accesses formation.

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Section: Discussionunclassified

Percutaneous nephrolithotripsy in children using miniature instruments.

Vardak,

Arustamov,

Rudin

et al. 2023

ECU

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“…Явления макрогематурии в послеоперационном периоде были продолжительнее в группе без использования гемостатического матрикса и с среднем продолжались 35 часов. Использование «безнефростомной» ПНЛ с аппликацией перкутанного доступа гемостатическим матриксом позволяет исключить возникновение паранефральной гематомы[36][37][38]. Тогда как в группе без введения матрикса данное осложнение отмечено в 17,8% случаев.…”

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The use of tubeless percutaneous nephrolithotripsy in children.

Vardak,

Arustamov,

Rudin

et al. 2023

ECU

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Introduction. Currently, percutaneous renal surgery is a common surgical procedure in urologic practice for the treatment of large and staghorn renal stones. Placement of a nephrostomy tube has been well recognized as a standard procedure to provide hemostasis, adequate drainage, and access for additional endoscopic procedures. At the same time, the use of a nephrostomy tube has negative consequences such as discomfort/pain symptom, longer hospital stay and possible urine extravasation. In view of the above, draining of the access tract raises questions in some cases. The aim of the study was effectiveness of tubeless percutaneous nephrolithotripsy in the treatment of urolithiasis in children. Materials and methods. Between 2013 and 2019, 66 patients (aged 1-17 y/o) underwent tubeless percutaneous nephrolithotomy (PNL) at the Department of Pediatric Urology of N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology. Patients were divided into three groups depending on the size of the instruments and the way the operation was completed. The first group (n=28) underwent surgery using the mini-PNL technique with the closure of the access tract. The second group (n=21) underwent surgery using the mini-PNL technique in the end of the surgery, moderate bleeding along the tract was detected in order to stop bleeding, a hemostatic matrix with thrombin was introduced. The third group (n=17) underwent surgery using the standard PNL technique and moderate bleeding was also determined in this group with the aim of tubeless completion, a hemostatic matrix with thrombin was introduced. Drainage of the upper urinary tract in the postoperative period was carried out by "JJ"-internal and "J"-external ureteral stents, which were held for up to 14 days. Results. The complete removal of the calculus in one surgical session was similar in all three groups. In the first group there were 26 (92.8%) children, in the second group 19 (90.4%) and in the third group 16 patients (94.1%). In the first group it was 26 (92.8%) children, in the second group 19 (90.4%) and in the third group 16 patients (94.1%). The need for additional interventions after surgical treatment was 21.4% in the first group, 23.7% in the second and 17.5% in the third group. Febrile fever (persistent temperature 380 C) most often occurred in the first group – in 10.7% of cases, while in the second and third groups this complication was detected in 4.7% and 5.8% of cases, respectively. Gross hematuria in the postoperative period was noted in the group without the use of a hemostatic matrix, averaging 35 (2-115) hours. Conclusion. The proposed tubeless PNL with the use of a hemostatic matrix is indicated for children without bacteriuria, with complete removal of the calculus, in the absence of trauma of the pelvicalyceal system and intensive bleeding. The duration of gross hematuria decreased with the introduction of the matrix in standard tubeless PNL by 51.4% and in mini-PNL by 25.8% compared with the 1-st group

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