Çocukluk Çağı Böbrek Taşı Hastalığında Mini Perkütan Nefrolitotomi Tek Merkez Deneyimlerimizin Değerlendirilmesi

Abstract

Objective: Several methods including extracorporeal shock wave lithotripsy(ESWL), standard percutaneous nephrolithotomy(PCNL), mini-PCNL and retrograde intrarenal surgery(RIRS) have been recommended to treat kidney stones. A major advantage of mini-PCNL is that it provides similar stone-free and success rates and is less invasive when compared with standard PCNL. In this report, we evaluated our experiences and outcomes with mini-PCNL in a pediatric population. Material and Methods: From January 2011 to November 2016, the medical records and radiographic images of children who underwent mini-PCNL with a 15 Fr peel-away sheath and 12 Fr miniature nephroscope were evaluated. We reviewed the patients’ demographic details, hemogram, stone characteristics, stone free rate and success rates, additional procedures, complications, hospital stay and nephrostomy retrieval. Stones were classified according to kidney localization as simple (single calyx or pelvic stones) or complex (choraliform, pelvic+calyx stones or multiple calyx stones). Results: The study included 12 girls and 28 boys, with a mean age of 7.84±5.62 years (1-17 years). The mean diameter of the stones was 24.4±15.3 mm (10-65 mm). The mean stone size was 14.76±6.52 mm for the simple stone group and 35.05±15.22 mm for the complex stone group (p=0.000). The mean operative and fluoroscopy times were 89.17±31.48 minutes and 146.35±63.16 seconds. The first success rate was 55% (n=22). 8 patients underwent additional procedures and the success rate increased to 77.5% (n=31). The success rate was significantly higher in simple stones (95.2% vs. 57.9%; p=0.005). The complication rate of the mini-PCNL procedure was 22.5% (n=9). The mean hemoglobin decrease was 0.73±1.06 mg/dl and only 1 patient required a blood transfusion. The mean hospital stay and nephrostomy retrieval time was 3.77±2.32 and 2.00±1.70 days, respectively. Conclusion: Our experiences indicate that mini-PCNL is a safe and effective procedure for the management of renal stones in children and stone-free and success rates similar to standard PCNL are obtained.