Ultrasound-guided mini-percutaneous nephrolithotomy in the treatment of upper urinary tract stones in children: A single-center evaluation.

To evaluate the safety and efficacy of ultrasound-guided mini-percutaneous nephrolithotomy (mini-perc) for the treatment of upper urinary tract stones in children. We reviewed the records of 70 children with upper urinary tract stones who were treated with a mini-perc technique between July 2015 and April 2020. All puncture site selections and tract dilations were determined by Doppler ultrasonography. Patient age, height, weight, stone size, operation time, stone-free rate (SFR), postoperative complications, tubeless rate, and length of hospital stay (LOS) were recorded. Stone components were analysed using infrared spectroscopy. A total of 47 boys and 23 girls were included. Median weight and height of the patients were 18.5 kg and 110 cm, respectively. Median stone diameter was 2.0 cm. Median time to establish access was 4.0 min and median operation time was 25 min. Patients had median preoperative and postoperative haemoglobin levels of 121 and 113.5 g/L, median haemoglobin levels dropped to 8.0 g/L the day after surgery. No patient needed a blood transfusion. Eight children (11.4%) developed significant complications, including four cases with Clavien Grade I, one with Clavien Grade II, and three with Clavien Grade Ⅲ complications. One-day and 1-month follow-ups revealed a complete SFR of 95.7% (67/70) and 97.1% (68/70), respectively. Fifty-six patients (80.0%) did not require catheters of any type (total tubeless). Median LOS was 2.0 days. Ultrasound-guided mini-perc is safe and effective. The mini-perc technique is a feasible alternative for paediatric stone disease that does not result in major complications.

Comparison of super-mini versus mini percutaneous nephrolithotomy for the treatment of upper urinary tract stones in children: a single centre experience.

PURPOSE: The efficacy and safety of super-mini percutaneous nephrolithotomy (SMP, 14 Fr) was compared with mini percutaneous nephrolithotomy (MPCNL, 16 Fr) for the treatment of upper urinary tract stones in children (< 14 years old). METHODS: Clinical data of 133 paediatric patients with upper urinary tract stones treated with SMP or MPCNL between May 2012 and May 2019 were retrospectively analysed. The patients were divided into the SMP and MPCNL groups. Age, height, weight, stone size, operation time, stone-free rate (SFR), postoperative complications, tubeless rate, and length of postoperative hospital stay (LOS) were compared. RESULTS: There were 66 patients (49.6%) in the SMP and 67 patients (50.4%) in the MPCNL group. No significant difference in the median age, weight, height and operation time, and SFR existed between the patients of the two groups. Larger stones were removed via SMP compared to those removed with MPCNL (2.0 vs. 1.5 cm, P = 0.001). LOS for SMP patients was significantly lower than that for the MPCNL patients (2 and 6 days, respectively, P < 0.0001). The tubeless rate for SMP was significantly higher than that for MPCNL (100% vs. 0%, P < 0.0001). Total complication rate of MPCNL was significantly higher than that of SMP (25.3% vs. 7.5%, P = 0.006). No patient required blood transfusion, and septicaemia, and other serious complications did not occur. CONCLUSION: SMP is more effective than MPCNL for treating middle-sized upper urinary tract stones in children, and is associated with a shorter LOS and a higher tubeless rate.

Clinical application of super-mini PCNL (SMP) in the treatment of upper urinary tract stones under ultrasound guidance.

PURPOSE: To present the safety and efficacy of totally ultrasonography-guided Super-mini percutaneous nephrolithotomy (SMP) in the treatment of upper urinary tract stones both in children and adults. PATIENTS AND METHODS: We carried out SMP in 104 patients (including 48 children and 56 adults) with upper urinary tract stones between June 2015 and February 2017. All steps of renal access were performed by ultrasonography. The lithotripsy was performed using either Holmium laser or pneumatic lithotripter. Perioperative and postoperative parameters along with operative data were recorded in detail. RESULTS: The mean age of children and adult patients were 4.4 ± 3.6 and 44.3 ± 15.7 years old, respectively. The stone burden was comparable for both groups (1.72 ± 0.66 vs 1.74 ± 0.56 cm, p = 0.852). Mean operation time was not significant different between two groups (p = 0.052), while the mean haemoglobin drop in children was much lower in adult patients (6.3 ± 6.9 vs 10.9 ± 8.69, p = 0.004). Both groups had similar SFRs in postoperative 1 day and at 1-month follow-up (p = 1.000, p = 0.912). Mean hospital stay of children and adult patients was 2.3 ± 0.8 and 2.2 ± 0.76 days (p = 0.484). The total complication rate was significantly lower in two groups (p = 1.000); none of the patients required blood transfusion. CONCLUSIONS: Ultrasonography-guided SMP was a safe and effective treatment option for moderate-sized upper urinary tract stones, and has the advantage of preventing radiation hazard, especially for pediatric stone patients.

Evaluation of super-mini-percutaneous nephrolithotomy(SMP) for upper urinary stone of adults and children / 中华泌尿外科杂志

Objective To compare the safety and efficiency of totally ultrasonography-guided super-mini-percutaneous nephrolithotomy(SMP) in the treatment of upper urinary stone in adults and children (＜ 14years).Methods From May 2015 to July 2018,81 cases of children(53％) and 71 (47％) cases of adults with upper tract stones underwent the SMP by total ultrasound guidance.In the group of children,it's including 53 male and 28 female with 85 channels in total,the patients age ranged from 10 months to 14 years,[mean (56.0 ± 39.7) months],The stone size ranged from 0.8-3.5 cm,[mean (1.7 ± 0.7) cm].About stone distribution,42 cases of pelvic stones,25 cases of calyceal and pelvic stones,5 cases of calyceal stones,7 cases of upper uretaral stones,1 case of upper ureteral and calyceal stones,1 case of malformation with double renal pelvis and ureter.Urinary infection rate was 86.4％ (70/81),positive rate of urinary culture was 39.5％ (32/81).In the group of adults,it's including 43 male and 28 female,the patients aged from 18 to 81 years,[mean (44.1 ± 15.4) years],The stone size ranged from 1.0-3.0 cm,[mean (1.7 ± 0.6) cm].About Stone distribution,19 cases of pelvic stones,13 cases of calyceal and pelvic stones,7 cases of calyceal stones,24 cases of upper uretaral stones,3 cases of upper ureteral and calyceal stones,1 case of malformation with double renal pelvis and ureter.Urinary infection rate was 87.3％ (62/71),positive rate of urinary culture was 26.8％ (19/71).The patient was placed in the lithotomy position under general anesthesia.A 5F ureteric catheter was retrogradely inserted into the collecting system and urethral catheter was placed in the bladder.The patient was then turned prone.The selected calix was punctured under ultrasound guidance by 18G puncture needle and a 0.032 inch guidewire was inserted into the collecting system.Nephrostomy tract was established using Dilators(it was done in one step for 12F and in two steps for 14F).After the corresponding size of suction-evacuation sheath was placed,the sheath was connected to the specimen collection bottle via the oblique branch of a metal connector.The miniature endoscope was inserted into the sheath to observe the collecting system and stone fragmentation was completed by using YAG laser or pneumatic lithotripter.Stone free rate after surgery at lday(SFR) and 1 month(1 month SFR),stone size,operative time(from starting fragmentation to the end of the surgery),hemoglobin drop and hematocrit drop in the first day after surgery,rate of surgecal complications,tubeless rate (totally tubless:no ureteric stent and nephrostomy tube;tubeless:no nephrostomy tube but ureteric stent),average length of hospital stay and urinary infection were recorded and compared.Results In children group,mean operative time was (27.7 ± 13.0)min(range 5-60 min),SFR and SFR at 1 month were 96.3％ (78/81)and 98.8％ (80/81),mean hemoglobin drop was (8.0 ± 9.1) g/L(range 0-41 g/L),mean hematocrit drop was 0.026 ±0.029(range 0-0.135),totally tubeless rate was 86.4％ (71/81),mean hospital stay was (2.5 ±0.9)days(range 1-5 days).Complications were observed in 9 cases and classified using Calvien grading system,Grade Ⅰ in 8 cases:postoperative fever in 4,hematuresis in 1,perirenal hematoma,postoperative distal ureteral stone in 1 cases and delayed recovery of intestinal function in 1 case,all had a spontaneous recovery without special managements;Grade Ⅲ b in 1 case,massive ascites was discovered during the surgery,and rcovered by puncture drainage.In adult group,mean operative time was (31.2 ± 15.3) min(range 7-80 min),SFR and SFR at 1 month were 97.2％ (69/71) and 98.6％ (70/71),mean hemoglobin drop was (11.9 ± 8.7) g/L (range 0-32 g/L),mean hematocrit drop was 0.030 ± 0.027 (range 0-0.106),totally tubeless rate was 87.3％ (62/71),mean hospital stay was (2.4 ± 1.1) days (range 1-8 days),urinary infection rate was 87.3％ (62./71),positive rate of urinary culture was 26.8％ (19/71).Complications were observed in 4 cases,Grade Ⅰ in 3 cases:hematuresis in 2 and delayed recovery of intestinal function in 1 case,all had a spontaneous recovery without special managements;Grade Ⅲ b in 1 case,postoperative distal ureteral stone in 1 cases and cured by ureteroscopic lithotripsy.According to data about Hb drop,risk of hemorrhage is lower in children than adult significantly (P ＜ 0.05).There is not significant difference in stone free rate,stone size,operative time,hematocrit drop,surgery complications,totally tubeless rate,stone complexity,average length of hospital stay and urinary infection (P ＞ 0.05).Conclusions With the characteristics of safe,efficacious and rapid recovery,super-mini-percutaneous nephrolithotomy (SMP) can be used as the first choice of the treatment for upper urinary stone both in adults and children.

Evaluation of super-mini-percutaneous nephrolithotomy(SMP) for upper urinary stone of adults and children / 中华泌尿外科杂志

Objective@#To compare the safety and efficiency of totally ultrasonography-guided super-mini-percutaneous nephrolithotomy(SMP) in the treatment of upper urinary stone in adults and children(<14years).@*Methods@#From May 2015 to July 2018, 81 cases of children(53%) and 71(47%) cases of adults with upper tract stones underwent the SMP by total ultrasound guidance. In the group of children, it’s including 53 male and 28 female with 85 channels in total, the patients age ranged from 10 months to 14 years, [mean (56.0±39.7) months], The stone size ranged from 0.8-3.5 cm, [mean (1.7±0.7)cm]. About stone distribution, 42 cases of pelvic stones, 25 cases of calyceal and pelvic stones, 5 cases of calyceal stones, 7 cases of upper uretaral stones, 1 case of upper ureteral and calyceal stones, 1 case of malformation with double renal pelvis and ureter. Urinary infection rate was 86.4%(70/81), positive rate of urinary culture was 39.5%(32/81). In the group of adults, it’s including 43 male and 28 female, the patients aged from 18 to 81 years, [mean (44.1±15.4)years], The stone size ranged from 1.0-3.0 cm, [mean (1.7±0.6)cm]. About Stone distribution, 19 cases of pelvic stones, 13 cases of calyceal and pelvic stones, 7 cases of calyceal stones, 24 cases of upper uretaral stones, 3 cases of upper ureteral and calyceal stones, 1 case of malformation with double renal pelvis and ureter. Urinary infection rate was 87.3%(62/71), positive rate of urinary culture was 26.8%(19/71). The patient was placed in the lithotomy position under general anesthesia. A 5F ureteric catheter was retrogradely inserted into the collecting system and urethral catheter was placed in the bladder. The patient was then turned prone. The selected calix was punctured under ultrasound guidance by 18G puncture needle and a 0.032 inch guidewire was inserted into the collecting system. Nephrostomy tract was established using Dilators(it was done in one step for 12F and in two steps for 14F). After the corresponding size of suction-evacuation sheath was placed, the sheath was connected to the specimen collection bottle via the oblique branch of a metal connector. The miniature endoscope was inserted into the sheath to observe the collecting system and stone fragmentation was completed by using YAG laser or pneumatic lithotripter. Stone free rate after surgery at 1day(SFR) and 1 month(1 month SFR), stone size, operative time(from starting fragmentation to the end of the surgery), hemoglobin drop and hematocrit drop in the first day after surgery, rate of surgecal complications, tubeless rate(totally tubless: no ureteric stent and nephrostomy tube; tubeless: no nephrostomy tube but ureteric stent), average length of hospital stay and urinary infection were recorded and compared.@*Results@#In children group, mean operative time was (27.7±13.0)min(range 5-60 min), SFR and SFR at 1 month were 96.3%(78/81)and 98.8%(80/81), mean hemoglobin drop was (8.0±9.1)g/L(range 0-41 g/L), mean hematocrit drop was 0.026±0.029(range 0-0.135), totally tubeless rate was 86.4%(71/81), mean hospital stay was (2.5±0.9)days(range 1-5 days). Complications were observed in 9 cases and classified using Calvien grading system, Grade Ⅰ in 8 cases: postoperative fever in 4, hematuresis in 1, perirenal hematoma, postoperative distal ureteral stone in 1 cases and delayed recovery of intestinal function in 1 case, all had a spontaneous recovery without special managements; Grade Ⅲb in 1 case, massive ascites was discovered during the surgery, and rcovered by puncture drainage.In adult group, mean operative time was (31.2±15.3)min(range 7-80 min), SFR and SFR at 1 month were 97.2%(69/71) and 98.6%(70/71), mean hemoglobin drop was (11.9±8.7)g/L(range 0-32 g/L), mean hematocrit drop was 0.030±0.027(range 0-0.106), totally tubeless rate was 87.3%(62/71), mean hospital stay was(2.4±1.1)days(range 1-8 days), urinary infection rate was 87.3%(62/71), positive rate of urinary culture was 26.8%(19/71). Complications were observed in 4 cases, Grade Ⅰ in 3 cases: hematuresis in 2 and delayed recovery of intestinal function in 1 case, all had a spontaneous recovery without special managements; Grade Ⅲb in 1 case, postoperative distal ureteral stone in 1 cases and cured by ureteroscopic lithotripsy. According to data about Hb drop, risk of hemorrhage is lower in children than adult significantly(P<0.05). There is not significant difference in stone free rate, stone size, operative time, hematocrit drop, surgery complications, totally tubeless rate, stone complexity, average length of hospital stay and urinary infection(P>0.05).@*Conclusions@#With the characteristics of safe, efficacious and rapid recovery, super-mini-percutaneous nephrolithotomy(SMP) can be used as the first choice of the treatment for upper urinary stone both in adults and children.

Super-mini PCNL (SMP): Material, indications, technique, advantages and results.

OBJECTIVE: To introduce an emerging technique termed 'super-mini- percutaneous nephrolithotomy' (SMP) and describe its application in practice. METHODS: We described the technique of SMP in the treatment of renal stones with emphasis on the material, indications, technique procedure, advantages, and results. RESULTS: SMP refers to a 7 Ch. nephroscope placed through a 10-14 Ch. metal access sheath with functions of both irrigation and suction-evacuation, to achieve stone fragmentation via laser or pneumatic lithotripsy. We reported our experience of this technique in 342 cases including 231 adults and 111 children. The mean stone size was 2.3 ± 0.9 cm resulted in 54.3 ± 27.7 min of mean operative time in adults, as well as 39.4 ± 26.2 min for stone size of 1.4 ± 0.5cm in children. In parallel, the initial stone-free rate (SFR) was 89.2% and 90.0% followed with a 94.4% and 95.5% of final SFR at 3 months in adults and children, respectively. No transfusions were needed in all patients. Tubeless was achieved in 93.9% and 100%of patients in adults and children respectively. The mean hospital stay was 2.3 ± 0.8 d and 2.7 ± 1.5 d respectively. CONCLUSIONS: SMP are suited for stones less than 2.5 cm in size. It is also suited for special situations such as pediatric moderate-sized stones, previously failed SWL or RIRS approaches. It has advantages of a shorter operative time and hospital stays, with a largely reduction use of drainage catheter after procedure. The indications of the SMP may also compete with those of SWL and RIRS.

Super-mini PCNL (SMP): Material, indications, technique, advantages and results / Supermini NLP (SMP): Material, indicaciones, técnica, ventajas y resultados

OBJECTIVE: To introduce an emerging technique termed 'super-mini- percutaneous nephrolithotomy' (SMP) and describe its application in practice. METHODS: We described the technique of SMP in the treatment of renal stones with emphasis on the material, indications, technique procedure, advantages, and results.RESULTS: SMP refers to a 7 Ch. nephroscope placed through a 10-14 Ch. metal access sheath with functions of both irrigation and suction-evacuation, to achieve stone fragmentation via laser or pneumatic lithotripsy. We reported our experience of this technique in 342 cases including 231 adults and 111 children. The mean stone size was 2.3 ± 0.9 cm resulted in 54.3 ± 27.7 min of mean operative time in adults, as well as 39.4 ± 26.2 min for stone size of 1.4 ± 0.5cm in children. In parallel, the initial stone-free rate (SFR) was 89.2% and 90.0% followed with a 94.4% and 95.5% of final SFR at 3 months in adults and children, respectively. No transfusions were needed in all patients. Tubeless was achieved in 93.9% and 100% of patients in adults and children respectively. The mean hospital stay was 2.3 ± 0.8 d and 2.7 ± 1.5 d respectively. CONCLUSIONS: SMP are suited for stones less than 2.5 cm in size. It is also suited for special situations such as pediatric moderate-sized stones, previously failed SWL or RIRS approaches. It has advantages of a shorter operative time and hospital stays, with a largely reduction use of drainage catheter after procedure. The indications of the SMP may also compete with those of SWL and RIRS

OBJETIVOS: Introducir una técnica emergente llamada super mini nefrolitotomía percutánea (SMP) y describir su aplicación en la práctica clínica. MÉTODOS: Describimos la técnica de SMP en el tratamiento de la lithiasis renal con énfasis en el material, las indicaciones, la operación, las ventajas y los resultados. RESULTADOS: La SMP se refiere al uso de un nefroscopio 7 Ch. alojado en una vaina de acceso metálica del 10-14 Ch. con la doble función de irrigación y aspiración-evacuación para conseguir la fragmentación de la litiasis con láser o litotricia neumática. Comunicamos nuestra experiencia en esta técnica en 342 casos incluyendo 231 adultos y 111 niños. El tamaño medio de la litiasis fue de 2,3 ± 0,9 cm resultado en 54,3 ± 27,7 min de operación en adultos, así cómo 39,4 ± 26,2 min para un tamaño de litiasis de 1,4 ± 0,5 cm en niños. En paralelo, el porcentaje de pacientes libres de litiasis fue del 89,2% y 90,0%, seguido por un 94,4% y 95,5% final a los 3 meses en adultos y niños respectivamente. Ningún paciente necesitó transfusión. El 93,9% y 100% de los pacientes se manejaron sin nefrostomía, adultos y niños respectivamente. La estancia media fue de 2,3 ± 0,8 y 2,7 ± 1,5 días respectivamente. CONCLUSIONES: La SMP es adecuada para piedras de tamaño menor de 2,5 cm. También es adecuada para situaciones especiales como litiasis de tamaño moderado en niños, fallo previo de LEOC o CRIR. Tiene la ventaja de un tiempo operatorio y estancia hospitalaria más cortos, con una reducción considerable del uso de catéter de drenaje después de la operación. Las indicaciones de SMP también pueden competir con las de LEOC o CRIR

Super-Mini Percutaneous Nephrolithotomy in the Treatment of Pediatric Nephrolithiasis: Evaluation of the Initial Results.

OBJECTIVE: To evaluate the efficacy and safety of super-mini percutaneous nephrolithotomy (SMP) in the treatment of pediatric kidney stones. PATIENTS AND METHODS: We reviewed the records of 111 children with renal stones treated with SMP technique in four different centers between September 2014 and September 2015. The indications for SMP treatment in all these kids were either previously failed shock wave lithotripsy or retrograde intrarenal surgery approaches, according to their parents' preferences. Nephrostomy tracts used in the SMP system ranged from 10F to 14F in size. Lithotripsy was performed using either a Holmium laser or pneumatic lithotripter. Perioperative and postoperative parameters along with operative data were recorded in detail and stone components were analyzed by infrared spectroscopy. RESULTS: This study included 71 boys and 40 girls with a mean age of 3.90 ± 3.53 years (range 0.5-15). The mean stone burden was 1.4 ± 0.6 cm (range 0.8-4.8). Mean operative time was 39.4 ± 26.2 minutes (range 7-105). The mean hemoglobin drop was 10.2 ± 7.1 g/L (range 0-25) and no transfusion was needed. Significant complications were observed in 17 (15.3%) children with 10 and 7 cases in Clavien grade I and grade II, respectively. Complete stone clearance on postoperative day 1 and on 3-month follow-up was 84.7% (94/111) and 90.1% (100/111), respectively. Ninety-five (85.6%) children did not require any type of catheters (total tubeless). The mean hospital stay was 2.7 ± 1.5 days (range 1-7). CONCLUSIONS: Our preliminary data demonstrated that SMP was safe and effective. SMP could be a feasible treatment option for pediatric stone disease. Further randomized controlled trials are still needed to prove the efficacy of using the SMP system in children, particularly in those with larger stones.

Super mini-percutaneous nephrolithotomy (SMP) by ultrasound-guided for pediatric kidney stones / 中华泌尿外科杂志

Objective To evaluate the safety and efficacy of super mini-percutaneous nephrolithotomy (SMP) by ultrasound-guided renal access in pediatric with renal calculus.Methods From May to August 2015, 20 pediatric patients with upper tract stones underwent the SMP by ultrasound guidance.The patients aged 11-144 months , median age 31.5 months, The stone size ranged 0.8-2.5 cm, mean(1.48 ±0.59) cm.Among the 20 children, single pelvis stones were in 8, multiple stones in 10 and upper ureter stones in 2.All patients had no previous surgery treatment.The SMP system consists of a F6.0 -7.5 nephroscope and a modified F12-14 access sheath with suction-evacuation function.Nephrostomy tract dilation was performed up to F12-14 and lithotripsy procedure was performed by using pneumatic lithotripter.Nephrostomy tube or double J stent was placed only if clinically indicated.Results The stone size was 0.8-2.5 cm ,mean (1.48 ± 0.59)cm.Among the 20 children, there were 8 patients with single pelvis stone, 10 with multiple stones and 2 with upper ureter stones.All the patients were completed successfully without surgery conversion.Mean operative time ranged 6-40 minutes ,mean(17.6 ± 11.6) minutes.The stone free rate was 100％ after the evaluation in the postoperative day.The hemoglobin drop was 2-16 g/L,mean (7.6-± 4.1) g/L.No major complications occurred, neither patient required transfusion.The tubeless PCNL without double J stents and nephrostomy tubes placed were achieved in all patients.Only 14 patients had a ureter catheter placement for one day.The average hospital stay ranged 1-4 days, mean (2.4 ± 0.8) days.Conclusions SMP could be a safe and effective treatment for kidney stone up to 2.0 cm in pediatric cases with advantages of short recovery time, high stone free rate and no catheter placement.SMP could be the ideal procedure for children with upper urinary tract calculus.