Treatment of pediatric renal calculi with mini-percutaneous nephrolithotomy

Objective To evaluate the surgical techniques and clinical effects of mini-percutaneous nephrolithotomy (mini-PCNL)in pediatric renal calculi.Methods The clinical data of 35 cases (21 males and 14 females,age ranged from 2 to 14 years with the mean of 7 years) treated by this method were retrospectively analyzed.Twenty-four cases were visited for hematuria and/or lumbago and 9 cases for urinary frequency while 2 were discovered by routine examination.Thirty-five cases were obtained final diagnosis by B-us,KUB+ IUV and CT.Twenty-eight cases had hydronephrosis.Nineteen cases were in the left side and 16 in the right.Seven cases were complicated by the renal calices cervical stenosis. Thirty-one cases had multiple calculi (13 cases were staghorn calculi l) while 4 cases had single pelvis calculus.The calculi size ranged from 0.8cm 1.4cm to 2.6cm 3.8cm .Ureteral catheter was antidrom-intubated from ureterostoma to renal pelvis or abutting stone under anesthesia.18G renal transfixion pin was punctured to select renal calices by monitoring with B-us.Extender expanded renal punctuation tunnel to 16F size.16F plastic cannula was pushed in to establish passageway.Calculi were searched for by ureteroscope and shredded by lithotripsy of air-pressure lithotripter.Gallet shred was dislodged.Seven cases with cervical stenosis were treated by distension.F_ 5 D-J catheter and renal drainage tube were inserted. Results The tunnel was successfully established in all patients by one time punctuation.The operative time ranged from 45 to 200min (mean 110min).Bleeding amount ranged from 10 to 40ml (mean 20ml) and no case needed for blood transfusion.Calculi were completely removed in 22 cases.One case appeared secondary bleeding 4d later (amount 200ml) and was recovered with anti-infection and absolute bed rest.Nine were completely removed in 12 cases with the second mini-PCNL by quondam sinus tract (8 cases) or by the second punctuation (4 cases).One case could not be completely removed even by three times of mini-PCNL.Leftover calculi in 4 cases were treated by ESWL and 2 cases were removed completely.All cases were followed up for 2 to 32 months.Hydronephrosis was obviously extenuated.Calculus had no recurrence.Renal cervical stenosis was disappeared in 7 cases.The size of the leftover calculus in 1 case was increasing.Conclusions Mini-PCNL is a safe,effective and less trauma treatment for pediatric renal calculi.Combination of mini-PCNL and ESWL can displace opening operation.