Minipercutaneous nephrolithotripsy in children

Abstract

Urolithiasis is a multifactorial disease, which based on the interaction of the genotype with the external environment. In recent years, a percutaneous nephrolithotripsy (PCNL), as opposed to extracorporeal shock-wave lithotripsy (ESWL) and moreover «open» surgery, arises at the first plan of treatment in patients with the large and coral renal stones.
Objective – to optimize the treatment of urolithiasis in children by implementing minimally invasive technologies.
Material and methods. Clinical material includes 27 patients with urolithiasis aged from 1 to 18 years. All patients diagnosed with unilateral lesions. Stones were located in a pyelocaliceal system (PCS). In one patient the concrements were formed in the left segment of the horseshoe kidney and in one girl in 7 years’ time after the pyeloplasty of the right kidney segment. In the diagnostic algorithm of kidney stone disease, the size and location of the concretions were determined, as well as the renal function and possible concomitant defects or complications.
Results. The technique used by the miniPCNL involves the puncture of PCS and the channel’s dilation under control of the polypositional radioscopy to provide access to kidney stone, the introduction of nephroscope in a channel, crushing of the stone and its fragments extraction. If necessary, when locating concretes in hard-to-reach calyx, the second puncture access to the CPS was used. With the help of miniPCNL we removed all fragments of concretions – «stone free». There were no complications during surgical interventions.
Conclusions. In the case of the large renal stones in children who are resistant to ESWL, the most optimal method of their removal is the contact PCNL. This is especially true while deals with the lower calyx concrete localization, which is anatomically problematic for the independent removal of stone fragments. The advantages of miniPCNL in children are as follows: a minimal surgical trauma and, usually, blood loss; good visualization of intervention subject; sufficient safety of operation and short hospital stay. MiniPCNL can be recommended in children with concomitant urinary tract defects and after previous traditional surgical interventions.