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S9-5
(PP)
MINI PERCUTANEOUS NEPHROLITHOTOMY WITH HOLMIUM YAG LASER IN
PEDIATRIC PATIENTS WITH HIGH VOLUME RENAL STONES
Clara CENTENO, Esteban EMILIANI, Anna BUJONS, Felix MILLAN, Jorge CAFFARATTI and Humberto VILLAVICENCIO
Fundacio Puigvert, Pediatric Urology, Barcelona, SPAIN
PURPOSE
Extracorporeal shock wave lithotripsy (SWL) is the treatment of choice for most cases of renal lithiasis in children. Some
cases, however, are refractory to SWL and may be associated with anatomical or metabolic changes. In this scenario
mini percutaneous nephrolithotomy (miniPCNL) constitutes an option.
Objective
To discuss our initial experience of miniPCNL with Holmium YAG laser (Ho: YAG) in children using the 0º-90º-puncture
technique and to report its efficacy and outcomes.
MATERIAL AND METHODS
We retrospectively reviewed the clinical records of 35 patients who underwent
miniPCNL between January 2008 and December 2012. 66.7% of patients had undergone a previous SWL (28.6% four
sessions). The miniPCNL puncture technique used was trough fluoroscopic guidance with the C arm at 0-90º in supine
position. 18-Fr to 22-Fr tract were performed. When necessary stone fragmentation was performed with a 100 W
Ho:YAG laser.
RESULTS
35 miniPCNLs were performed in 33 patients (27 boys and 6 girls) with a mean age of 7 years (range 2-20). 10 of the
PCNLs (28.6%) were right sided, and 25 were left (71.4%). 24 of the patients (69%) presented with anatomical or
metabolic changes. Stone location was in 64% of patients in the lower calyceal group and 50% in the renal pelvis. Mean
stone size was 4.46 cm2 (3-13.20). The number of stones varied between 1 and 20, and 83.3% were radiopaque. The
mean surgical time was 180 min. In 78% of patients the stones disappeared completely. Overall stone free rate was
achieved in 85% of cases. Residual stones were treated either with SWL or RIRS. No perioperative complications were
seen.
CONCLUSIONS
In paediatric population miniPCNL is feasible and safe being the technique of choice for high volume urolithiasis
refractory to SWL.