Abstract
Background:
Childhood urolithiasis is a major health problem in developing countries, especially in endemic regions. The incidence of childhood urolithiasis ranges increases in the endemic areas of the world, such as Uzbekistan. Percutaneous nephrolithotomy (PCNL) is useful with high stone clearance with low morbidity for upper urinary tract stones >1.5 cm. The miniaturizing of instruments has been shown to significantly reduce intra- and postoperative hemorrhage, renal parenchymal injury, postoperative pain, and length of hospital stay. The need for postoperative cystoscopy for ureteral stent removal is one of the limitations of tubeless mini-PCNL in children, which needs narcotics, postoperative urination discomfort, and sometimes hospital stays for children.
Objectives:
This study aims to evaluate the safety and efficacy of mini-PCNL with antegrade stent tether in preschool children.
Materials and Methods:
From 2018 to August 2021, in our medical center, 138 preschool children underwent tubeless mini-PCNL with antegrade stent tether. All procedures performed by Storz MIP system 12F nephroscope, using 16F metallic sheath. Stone fragmentation was performed by holmium laser and pneumatic lithotriptor. All cases were finished with antegrade stent placement with a proximal tether through the percutaneous tract, protected by a clear occlusive bandage. The polypropylene thread was sutured through the stent's proximal lumen and from inside to outside, which contributed to the easy removal whereas minimizing damage to surrounding tissue with the tip of the stent. Some ureteral stents come with a tether, which can be used in this technique, avoiding the polypropylene stitch. In these types of stents surgeons should pay attention to the thickness of tether, because thin tethers can tear during the removal.
Results:
A total of 138 children—92 (66.6%) boys and 46 (33.3%) girls, with a mean age of 54.5 (17–75) months were included in this study. The mean size of the stones was 29.5 (19–41) mm. Renal stones were located in renal pelvis in 66 (47.8%) patient, in lower pole in 28 (20.2%) patient, in central region/upper pole in 17 (12.3%) and in 27 (19.5%) patients were staghorn stones. All intrarenal access was performed in the prone position under ultrasonography and fluoroscopic guidance. In 12 cases required additional access with 12F sheath. Stone-free rate was 98%. Mean operative time was 68.5 (45–92) minutes. Hospital stay time was 2–3 days in all cases. There was no significant bleeding that necessitated transfusion. Overall complications Clavien I–II were noted in 19 (13.7%) patients; none of the patients had severe complications (Grades III, IV, and V). In all cases, the ureteral stent was removed by tether through flank without anesthesia in the office, in 87 (63%) cases on the fourth day and in 51 (36.9%) cases on the sixth day after surgery. There was no incidence of bleeding and pain during stent removal.
Conclusions:
Tubeless mini-PCNL with stent tether is a safe and effective technique for preschool children, which avoids the possibility of postoperative cystoscopy, additional anesthesia, hospital stay, and allows easy access to the caliceal system for second look nephroscopy when it needs.
No competing financial interests exist
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Author(s) have received and archived patient consent for video recording/publication in advance of video recording of the procedure.
Music: Yanni—The Flame Within.
Runtime of video: 5 min 3 secs
