Clinical efficacy of percutaneous nephrolithotomy with all-seeing needle system in treatment of upper urinary calculi in children

Abstract

Objective To evaluate the effectiveness and safety of percutaneous nephrolithotomy(PCNL) with the all-seeing needle system(Microperc)for the treatment of upper urinary calculi in children. Methods Retrospective analysis of 25 cases of upper urolithiasis treated with Microperc from November 2016 to January 2018 in Guizhou Provincial People′s Hospital was performed, including 18 boys and 7 girls.The age of patients was (6.4±3.9) years(10 months-14 years), and 4 cases were less than 3 years old.Among them, 3 cases had upper ureteral calculi and 22 cases had renal calculi.The mean stone size was 14.5 mm(8-20 mm). Stone fragmentation was performed by using a 200 μm holmium(YAG laser fiber). Results All patients were successfully treated in stage I. In 6 patients, access was achieved through the 4.8Fr all-seeing needle method.Conversion to mini-PCNL (10-12Fr) was required in 19 patients due to intraoperative bleeding and high stone burden.The duration of operation time was (60.8±15.1) min (40-100 min). The mean postoperative drop in hemoglobin was (7.5±5.4) g/L, and no patient required blood transfusion.The hospital stay was (4.9±1.2) days (3-6 days). There were residual fragments in 3 patients, and the overall stone-free rate at 4 weeks was 88%(22/25 cases). Four cases had a fever(Clavien grade Ⅰ) complications, while no grade Ⅱ and grade Ⅲ complications were observed. Conclusions Microperc can establish a surgical channel through visual images quickly and safely, and it greatly reduces the risk and difficulty in doing operation.This technology is not only suitable for learner of surgery, but also for patients with mild hydronephrosis and children with calculus. Key words: All-seeing needle system; Percutaneous nephrolithotomy; Upper urinary calculi; Child