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EFFECT OF SIZE AND SITE ON OUTCOME OF MINI-PERCUTANEOUS
NEPHROLITHOTOMY FOR RENAL STONES IN INFANTS AND PRESCHOOL
CHILDREN: A PROSPECTIVE STUDY
Mohammed Said ELSHEEMY, Kareem DAW, Ahmed SHOUMAN, Ahmed SHOUKRY, Waseem ABOULELA, Hany MORSI,
Hesham BADAWY and Mohamed EISSA
Cairo University, Urology department, Giza - Cairo, EGYPT
PURPOSE
Reports on Miniperc are still few. Nearly, all of them are retrospective. Most of them used sheath size of ≥18Fr which is
still relatively large for young children. To the best of our knowledge, the present study may be the first prospective
study assessing safety and efficacy of Miniperc for renal stones in preschool age patients.
MATERIAL AND METHODS
From January2012 to May2013, Miniperc was performed for 26children(≤6years old) with renal calculi<5cm through
14Fr sheath using 9.5Fr semirigid ureteroscope with Holmium:YAG laser Lithotripsy. Stones>2cm(38.5%), resistant to
ESWL(34.6%) or alkalinization(11.5%), associated with moderate to severe hydronephrosis(7.7%), on top of retracted
stent(3.8%)or secondary to PUJ-O(3.8%) were included. Effects of different factors on operative time, complications and
stone-free rate(SFR) were recorded and compared.
RESULTS
Age and stone size were 43±15(15-72)months and 19.6±11.29(5-48)mm, respectively. Multiple stones were present in
12(46%)patients. Stones were present in renal pelvis(61.5%) or in pelvis combined with calyces(38.5%). Operative
duration, Hemoglobin loss and hospital stay were 71±30(25-150)min, 0.78±0.86(0-3.3)mg/dl and 3.8±2.07(1-10)days,
respectively. Supra costal or >1puncture were needed in 3(11.5%) and 1(3.8%)patient(s), respectively. Primary-SFR,
SFR after second-look Miniperc and after ESWL were 77%, 85% and 92%, respectively. Retreatment rate was 8%.
Auxiliary ESWL was done in 11%. The only case with failure had 3mm clinically insignificant residual fragment.
Complications were bleeding(8%), hematuria and blood transfusion(4%), renal pelvis perforation(4%), leakage(8%)
and fever(15%). No patient developed hypothermia. 4(15.4%)patients required double J stenting at end of procedure.
Operative time was significantly prolonged in multiple(>2) stones(p=0.006), calyceal stones(p=0.002) or stone
size≥30mm(p=0.022). SFR was significantly lower in children with >2stones(43%)(p=0.028) and increased stone
size≥30mm(40%)(p=0.014). Complications rate was not affected by technique of dilatation or number, size or site of
stones(p>0.05).
CONCLUSIONS
Conclusions: Miniperc is safe and effective minimally invasive procedure for pediatric renal stones using 14Fr access
sheath. SFR was significantly lower in children with>2stones or increased stone size≥30mm.