Mini versus ultra-mini percutaneous nephrolithotomy in a paediatric population
Dilip K. Mishraa,Sonia Bhattb,Sundaram Palaniappanac*(),Talamanchi V.K. Reddya,Vinothkumar Rajenthirana,Y.L. Sreerangaa,Madhu S. Agrawala
a Department of Urology, Global Rainbow Hospital, Agra, Uttar Pradesh, India b Department of Pediatrics, F H Medical College, Agra, Uttar Pradesh, India c Department of Urology, Sengkang General Hospital, Singapore
Objective: To evaluate whether there would be a difference in outcome when the smaller ultra-mini 12 Fr sheath was used instead of the mini 16 Fr sheath for percutaneous nephrolithotomy (PCNL) in paediatric patients for stones less than 25 mm. Methods: This was a prospective cohort study of patients who underwent PCNL in our hospital in a 2-year period from July 2016 to June 2018 by a single surgeon. PCNL was performed in a prone position and tract was dilated to the respective size using single step dilatation. Laser was used to fragment the stone. Stone-free outcome was defined as absence of stone fragment at 3 months on kidney, ureter, and bladder X-ray. Results: There were 40 patients in each group. Mean stone size was comparable between the two groups (14.5 mm vs. 15.0 mm). The procedure was completed faster in the 16 Fr group compared to 12 Fr group (24.5 min vs. 34.6 min). Stone clearance was highly successful in both groups (97.5% vs. 95.0%). There was no difference in complications between the two groups. The decrease in hemoglobin was minimal in both groups (0.2 g/dL vs. 0.3 g/dL). Conclusion: We found that the success rates were similar in both mini PCNL and the smaller ultra-mini PCNL groups. No significant difference in bleeding was noted in our pilot study, however, operative time was longer in the ultra-mini group as compared to the mini sheath group.
. [J]. Asian Journal of Urology, 2022, 9(1): 75-80.
Dilip K. Mishra,Sonia Bhatt,Sundaram Palaniappan,Talamanchi V.K. Reddy,Vinothkumar Rajenthiran,Y.L. Sreeranga,Madhu S. Agrawal. Mini versus ultra-mini percutaneous nephrolithotomy in a paediatric population. Asian Journal of Urology, 2022, 9(1): 75-80.
Radmayr C, Bogaert G, Dogan HS, Ko_cvara R, Nijman JM, Steinet R, et al. European Association of Urology Guidelines on Pediatric Urology 2019. https://uroweb.org/guideline/paediatric-urology/#3. [Accessed 2 October 2019].
[5]
Yamaguchi A, Skolarikos A, Buchholz NP, Chomo′n GB, Grasso M, Saba P, et al. Operating times and bleeding complications in percutaneous nephrolithotomy: A comparison of tract dilation methods in 5537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. J Endourol 2011; 25:933e9.
[6]
Kukreja R, Desai M, Patel S, Bapat S, Desai M. Factors affecting blood loss during percutaneous nephrolithotomy: Prospective study. J Endourol 2004; 18:715e22.
[7]
Schilling D, Hüsch T, Bader M, Herrmann TR, Nagele U. Training and Research in Urological Surgery and Technology (T.R.U.S.T.) Group. Nomenclature in PCNL or the tower of babel: A proposal for a uniform terminology. World J Urol 2015; 33:1905e7.
[8]
Woodside JR, Stevens GF, Stark GL, Broden TA, Ball WS. Percutaneous stone removal in children. J Urol 1985; 134:1166e7.
[9]
Wang M, Bukavina L, Mishra K, Mahran A, Ponsky L, Gnessin E. Kidney volume loss following percutaneous nephrolithotomy utilising 3D planimetry. Urolithiasis 2020; 48:257e61.
[10]
Jones P, Bennett G, Aboumarzouk OM, Griffin S, Somani BK. Role of minimally invasive percutaneous nephrolithotomy techniquesdmicro and ultra-mini PCNL (<15F) in the pediatric population: A systematic review. J Endourol 2017; 31:816e24.
[11]
Nicklas AP, Schilling D, Bader MJ, Herrmann TR, Nagele U. The vacuum cleaner effect in minimally invasive percutaneous nephrolitholapaxy. World J Urol 2015; 33:1847e53.
[12]
Ganpule AP, Mishra S, Desai MR. Percutaneous nephrolithotomy for pediatric urolithiasis. Indian J Urol 2010; 26:549e54.
[13]
Kaygısız O, Satar N, Güneş A, Doğan HS, Erözenci A, Özden E, et al. Factors predicting postoperative febrile urinary tract infection following percutaneous nephrolithotomy in prepubertal children. J Pediatr Urol 2018; 14:448.e1e7. https://doi.org/10.1016/j.jpurol.2018.04.010.
[14]
Agrawal MS, Agrawal M. Percutaneous nephrolithotomy: Large tube, small tube, tubeless or totally tubeless? Indian J Urol 2013; 29:219e24.
[15]
Celik H, Camtosun A, Dede O, Dagguli M, Altintas R, Tasdemir C. Comparison of the results of pediatric percutaneous nephrolithotomy with different sized instruments. Urolithiasis 2017; 45:203e8.
[16]
Dede O, Sancaktutar AA, Dagguli M, Utangac M, Bas O, Penbegul N. Ultra-mini-percutaneous nephrolithotomy in pediatric nephrolithiasis: Both low pressure and high efficiency. J Pediatr Urol 2015; 11:253.e1e6. https://doi.org/10.1016/j.jpurol.2015.03.012.
[17]
Liu Y, AlSmadi J, Zhu W, Liu Y, Wu W, Fan J, et al. Comparison of super-mini PCNL (SMP) versus Miniperc for stones larger than 2 cm: A propensity score-matching study. World J Urol 2018; 36:955e61.
[18]
Karakan T, Kilinc MF, Doluoglu OG, Yildiz Y, Yuceturk CN, Bagcioglu M, et al. The modified ultra-mini percutaneous nephrolithotomy technique and comparison with standard nephrolithotomy: A randomized prospective study. Urolithiasis 2017; 45:209e13.
[19]
Karakan T, Kilinc MF, Bagcioglu M, Doluoglu OG, Yildiz Y, Demirbas A, et al. Comparison of ultra-mini percutaneous nephrolithotomy and micro-percutaneous nephrolithotomy in moderate-size renal stones. Arch Esp Urol 2017; 70:550e5.
[20]
Yavuz A, Kilinc MF, Bayar G. Outcomes of different minimally invasive techniques in lower calyceal stones of 1 to 2 centimeters: A prospective, randomized study. Arch Esp Urol 2020; 73:307e15.
