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.
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 rmm).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 rain).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.
ABSTRACT
Objective To explore the efficacy of Cohen ureteric reimplantation for congenital malformation of vesicoureteral junction in children.Methods From February 2014 to August 2016,12 children with congenital monstrositas of vesicoureteral junction obstruction who were treated with pneumoeystoscopic Cohen ureteric reimplantation in Guizhou Provincial People's Hospital were selected.In these cases,8 males and 4 females,their ages ranged from 2 months past 1 year to 11 years,and the average age was 5.26 years.In the 12 patients,there were 6 cases with left vesicoureteral junction obstruction,and 1 case with right vesicoureteral junction obstruction,1 case with left ureter cyst and duplication of ureter ectopic opening,1 case with right duplex kidney and ureter cyst,1 case with right primary vesicoureteric reflux and left vesicoureteral junction obstruction,2 cases with bilateral primary vesicoureteric reflux and 1 case with ureter cyst.A foley catheter and ureteral stent was indwelled in each patient but no bladder fistula was made.All of the patients underwent pneumocystoscopic Cohen ureteric reimplantation.The stenting catheters were removed in 1-3 months after surgery.B ultrasonography was used to follow the degree of the dilatation of ureter and hydronephrosis.Urinalysis was conducted to detect the urinary tract infection.Intravenous urography examination was conducted to detect anastomotic stenosis.Voiding cystourethrography was performed to show ureteral reflux.Results All procedures were accomplished without conversion.The duration of operations ranged from 100 to 330 min (mean 207 min).All patients were followed up for 3 to 10 months,but no urinary tract infection and anastomotic obstruction occurred,and B ultrasonography showed that hydronephrosis or dilatation of ureter were improved in different degrees or disappeared.Two cases of ureteral reflux occurred in the early follow-up,and these cases recovered after being given symptomatic treatment.Conclusions The pneumocystoscopic Cohen ureteric reimplantation is a safe and effective option for congenital malformation of vesicoureteral junction in children.