Microperc for pediatric nephrolithiasis

Technique in valdivia-modified position

Paolo Caione, Mauro De Dominicis, Giuseppe Collura, Ennio Matarazzo, Simona Gerocarni Nappo, Nicola Capozza

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Introduction Micropercutaneous nephrolithotomy (microperc) has been recently proposed in adult patients. We present our initial experience in children using a modified technical approach. Methods After the retrograde positioning of a 5F catheter, a 4.85F metallic needle (1.9 mm) was used for direct percutaneous calyceal access under ultrasonographic and fluoroscopic guidance with the patient in supine Valdivia-modified position. Once a three-way connector was inserted to the needle, stone fragmentation was performed under direct vision using a 200 μm holmium:YAG laser fiber and a 0.9-mm high-resolution (10,000 pixels) optic flexible wire connected with the telescope, with intermittent saline infusion. The transureteral catheter was removed within 18 to 24 hours. Results A total of five patients aged 18 months to 11 years (mean, 5.8 years) received microperc lithotripsy in a 6-month period. The mean stone size was 15.0 mm (±2.5 mm). Conversion to retrograde intrarenal surgery was necessary in one case, due to stone migration and poor visibility. Moderate hydronephrosis was present in one kidney. The mean operative time was 56 minutes (±23 minutes). The blood loss was insignificant (< 0.6 Hbg/dL) and postoperative discomfort was minimal. The mean hospital stay was 2.4 ± 0.6 days for four patients after the removal of ureteral catheter. The JJ stent was removed after 15 days in the last patient. The overall stone-free rate at 1 month was 100% and no ancillary procedures were required. Conclusions Microperc is a new cost-effective and time-saving technique that we demonstrated as safe and effective in minimally invasive procedure for lower pole and pelvic renal stones of small size. Indications and limits should be defined by multicenter randomized studies, comparing the former procedures.

Original languageEnglish
Pages (from-to)94-99
Number of pages6
JournalEuropean Journal of Pediatric Surgery
Volume25
Issue number1
DOIs
Publication statusPublished - 2014

Fingerprint

Nephrolithiasis
Pediatrics
Needles
Catheters
Telescopes
Kidney
Urinary Catheters
Lithotripsy
Hydronephrosis
Solid-State Lasers
Operative Time
Multicenter Studies
Stents
Length of Stay
Costs and Cost Analysis

Keywords

  • children
  • microperc
  • nephrolithiasis
  • percutaneous nephrolithotomy
  • Valdivia position

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Microperc for pediatric nephrolithiasis : Technique in valdivia-modified position. / Caione, Paolo; De Dominicis, Mauro; Collura, Giuseppe; Matarazzo, Ennio; Nappo, Simona Gerocarni; Capozza, Nicola.

In: European Journal of Pediatric Surgery, Vol. 25, No. 1, 2014, p. 94-99.

Research output: Contribution to journalArticle

@article{fb44f9b9af594420be29111d8fa6b602,
title = "Microperc for pediatric nephrolithiasis: Technique in valdivia-modified position",
abstract = "Introduction Micropercutaneous nephrolithotomy (microperc) has been recently proposed in adult patients. We present our initial experience in children using a modified technical approach. Methods After the retrograde positioning of a 5F catheter, a 4.85F metallic needle (1.9 mm) was used for direct percutaneous calyceal access under ultrasonographic and fluoroscopic guidance with the patient in supine Valdivia-modified position. Once a three-way connector was inserted to the needle, stone fragmentation was performed under direct vision using a 200 μm holmium:YAG laser fiber and a 0.9-mm high-resolution (10,000 pixels) optic flexible wire connected with the telescope, with intermittent saline infusion. The transureteral catheter was removed within 18 to 24 hours. Results A total of five patients aged 18 months to 11 years (mean, 5.8 years) received microperc lithotripsy in a 6-month period. The mean stone size was 15.0 mm (±2.5 mm). Conversion to retrograde intrarenal surgery was necessary in one case, due to stone migration and poor visibility. Moderate hydronephrosis was present in one kidney. The mean operative time was 56 minutes (±23 minutes). The blood loss was insignificant (< 0.6 Hbg/dL) and postoperative discomfort was minimal. The mean hospital stay was 2.4 ± 0.6 days for four patients after the removal of ureteral catheter. The JJ stent was removed after 15 days in the last patient. The overall stone-free rate at 1 month was 100{\%} and no ancillary procedures were required. Conclusions Microperc is a new cost-effective and time-saving technique that we demonstrated as safe and effective in minimally invasive procedure for lower pole and pelvic renal stones of small size. Indications and limits should be defined by multicenter randomized studies, comparing the former procedures.",
keywords = "children, microperc, nephrolithiasis, percutaneous nephrolithotomy, Valdivia position",
author = "Paolo Caione and {De Dominicis}, Mauro and Giuseppe Collura and Ennio Matarazzo and Nappo, {Simona Gerocarni} and Nicola Capozza",
year = "2014",
doi = "10.1055/s-0034-1387939",
language = "English",
volume = "25",
pages = "94--99",
journal = "European Journal of Pediatric Surgery",
issn = "0939-7248",
publisher = "Thieme Medical Publishers",
number = "1",

}

TY - JOUR

T1 - Microperc for pediatric nephrolithiasis

T2 - Technique in valdivia-modified position

AU - Caione, Paolo

AU - De Dominicis, Mauro

AU - Collura, Giuseppe

AU - Matarazzo, Ennio

AU - Nappo, Simona Gerocarni

AU - Capozza, Nicola

PY - 2014

Y1 - 2014

N2 - Introduction Micropercutaneous nephrolithotomy (microperc) has been recently proposed in adult patients. We present our initial experience in children using a modified technical approach. Methods After the retrograde positioning of a 5F catheter, a 4.85F metallic needle (1.9 mm) was used for direct percutaneous calyceal access under ultrasonographic and fluoroscopic guidance with the patient in supine Valdivia-modified position. Once a three-way connector was inserted to the needle, stone fragmentation was performed under direct vision using a 200 μm holmium:YAG laser fiber and a 0.9-mm high-resolution (10,000 pixels) optic flexible wire connected with the telescope, with intermittent saline infusion. The transureteral catheter was removed within 18 to 24 hours. Results A total of five patients aged 18 months to 11 years (mean, 5.8 years) received microperc lithotripsy in a 6-month period. The mean stone size was 15.0 mm (±2.5 mm). Conversion to retrograde intrarenal surgery was necessary in one case, due to stone migration and poor visibility. Moderate hydronephrosis was present in one kidney. The mean operative time was 56 minutes (±23 minutes). The blood loss was insignificant (< 0.6 Hbg/dL) and postoperative discomfort was minimal. The mean hospital stay was 2.4 ± 0.6 days for four patients after the removal of ureteral catheter. The JJ stent was removed after 15 days in the last patient. The overall stone-free rate at 1 month was 100% and no ancillary procedures were required. Conclusions Microperc is a new cost-effective and time-saving technique that we demonstrated as safe and effective in minimally invasive procedure for lower pole and pelvic renal stones of small size. Indications and limits should be defined by multicenter randomized studies, comparing the former procedures.

AB - Introduction Micropercutaneous nephrolithotomy (microperc) has been recently proposed in adult patients. We present our initial experience in children using a modified technical approach. Methods After the retrograde positioning of a 5F catheter, a 4.85F metallic needle (1.9 mm) was used for direct percutaneous calyceal access under ultrasonographic and fluoroscopic guidance with the patient in supine Valdivia-modified position. Once a three-way connector was inserted to the needle, stone fragmentation was performed under direct vision using a 200 μm holmium:YAG laser fiber and a 0.9-mm high-resolution (10,000 pixels) optic flexible wire connected with the telescope, with intermittent saline infusion. The transureteral catheter was removed within 18 to 24 hours. Results A total of five patients aged 18 months to 11 years (mean, 5.8 years) received microperc lithotripsy in a 6-month period. The mean stone size was 15.0 mm (±2.5 mm). Conversion to retrograde intrarenal surgery was necessary in one case, due to stone migration and poor visibility. Moderate hydronephrosis was present in one kidney. The mean operative time was 56 minutes (±23 minutes). The blood loss was insignificant (< 0.6 Hbg/dL) and postoperative discomfort was minimal. The mean hospital stay was 2.4 ± 0.6 days for four patients after the removal of ureteral catheter. The JJ stent was removed after 15 days in the last patient. The overall stone-free rate at 1 month was 100% and no ancillary procedures were required. Conclusions Microperc is a new cost-effective and time-saving technique that we demonstrated as safe and effective in minimally invasive procedure for lower pole and pelvic renal stones of small size. Indications and limits should be defined by multicenter randomized studies, comparing the former procedures.

KW - children

KW - microperc

KW - nephrolithiasis

KW - percutaneous nephrolithotomy

KW - Valdivia position

UR - http://www.scopus.com/inward/record.url?scp=84988041937&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84988041937&partnerID=8YFLogxK

U2 - 10.1055/s-0034-1387939

DO - 10.1055/s-0034-1387939

M3 - Article

VL - 25

SP - 94

EP - 99

JO - European Journal of Pediatric Surgery

JF - European Journal of Pediatric Surgery

SN - 0939-7248

IS - 1

ER -