Micropercutaneous nephrolithotomy. A new therapeutic option for pediatric renal lithiasis

Abstract

IntroductionMicropercutaneous nephrolithotomy is an evolution from the conventional percutaneous surgery in which pyelocaliceal access is obtained through minimum bore holes. Its objective is the complete removal of the calculi, lowering the morbidity associated with larger bore percutaneous tracts. Materials and methodsWe present the case of a micropercutaneous nephrolithotomy performed in a 14-year-old female patient with a 35mm diameter kidney stone located in the renal pelvis. Surgery was performed in the Galdakao-modified supine Valdivia position. Puncture was done under ultrasound and fluoroscopic guidance. The 4.85Ch needle of the Microperc® set was used, completing the procedure through the 8Ch working shaft. Lasertripsy was done with the Ho:YAG laser. An indwelling double J stent was placed at the end of the procedure. ResultsOperating time was 170min. Hospital stay was one day. She suffered renal colic after 72h, which was resolved with oral analgesic treatment at home (Clavien I). She returned to school on the fifth postoperative day. The double J was removed at two weeks. At one month of the surgery, the patient is asymptomatic, a 4mm lower calyx residual stone being observed in the abdominal ultrasound. ConclusionMicropercutaneous nephrolithotomy is a step forward toward the search for a less invasive kidney stone treatment. It is a safe and effective technique in the pediatric population, and it can be performed in the supine position, even in orthotropic kidneys. Future studies and collaborative works will help to better define its indications, to optimize its technique and to analyze its cost-effectiveness compared with other treatment options.