Abstract
Objective To compare the efficacy,safety,and morbidity of minimally invasive percutaneous nephrolithotomy under Doppler ultrasound guidance (MPCNL) and retrograde ureteroscopic lithotrispy (URSL) for upper and middle ureteral stones in children younger than 5 years.Methods Eightynine cases of children younger than 5 years from January 2008 to November 2011 were reviewed.There were 53 patients accepted MPCNL and 36 patients undergoing URSL.Patients who needed more than one percutaneous tract or had simultaneously undergone the two techniques on the same kidney or need more than one session surgery were excluded from the study.Results The two groups had comparable stone burden of (13.7±5.1) mm and (12.9±3.2) mm in MPCNL and URSL group respectively.The demographic data were similar as well.In MPCNL group,percutaneous-renal access was established and lithotripsy was preformed in one session,with the access time of (9.5±4.9) min and operative time of (35.8±7.6) min.The stone-free rate was 100.0％.The hemoglobin and hematocrit dropped by (6.72± 1.63) g/L and (2.34±0.57)％ respectively.The mean hospital stay after surgery was 8.5 d.The complication in MPCNL group was postoperative fever in 12 (22.6％) cases.No perioperative bleeding,renal lost or septic shock was recorded,and no transfusion was required.No perirenal organ injury was recorded.In URSL group,the operative time was (66.8 ± 28.5) min with the stone-free rate of 63.9％ in single session.The hemoglobin and hematocrit dropped by (4.42±1.52) g/L and (1.85±0.13)％ respectively.The mean hospital stay after surgery was 13.2 d.The complications of URSL group included postoperative fever in 19 (52.8％) cases,ureteral perforation in 7 cases.The mean follow-up duration was 24 months (range,16-38 months).Three (8.3％) ureteral stricture cases were recorded in URSL group postoperatively,which was not reported in MPCNL group.The MPCNL group was significant better than URSL group in terms of stone-free rate in one session,operative time and hospital stay (P＜0.05).Conclusion MPCNL could be safe and effective for managing proximal and middle ureteral stone in pediatric patients with significantly higher stone-free rate,shorter operative time and lower incidence of bleeding and less complications compared with URSL. Key words: Infant; Child, preschool ; Ureteral calculi ; Percutaneous nephrolithotomy ; Ureteroscopy
Published Version
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