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 language | English |
|---|---|
| Pages (from-to) | 94-99 |
| Number of pages | 6 |
| Journal | European Journal of Pediatric Surgery |
| Volume | 25 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 2014 |
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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 journal › Article
}
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 -