Percutaneous nephrolithotomy in infants and preschool age children: Experience with a new technique

Stephen V. Jackman, Sean P. Hedican, Craig A Peters, Steven G. Docimo

Research output: Contribution to journalArticle

223 Citations (Scopus)

Abstract

Objectives. To develop a less invasive method for performing percutaneous nephrolithotomy (PCNL) with the intent of decreasing the morbidity of the procedure in young children. Methods. A novel percutaneous renal access technique ('mini-perc') was developed using an 11F peel-away vascular access sheath. Tract dilation and insertion of the sheath into the collecting system was performed with a single pass over an access wire. PCNL was performed using pediatric instruments and electrohydraulic lithotripsy. Sheath design improvements were implemented that make it specific for pediatric PCNL. Results. Eleven procedures have been performed with the 11F sheath. Patient age ranged from 2 to 6 years (mean 3.4) and weight from 5 to 24 kg (mean 12.5). The average stone burden was 1.2 cm2. Mean procedure time, estimated blood loss, and length of hospitalization were 203 minutes, 25 mL, and 6 days, respectively. Six (85%) of 7 patients are currently stone free with an average follow-up of 12 weeks. No patient required transfusion, developed urosepsis, or had a procedure-related complication. One procedure was performed in an outpatient setting with no postoperative nephrostomy tube. Conclusions. The 11F 'mini-perc' technique was successful in rendering 85% of patients stone free with minimal morbidity. Its advantages over obtaining acceSS with standard 24 to 34F access sheaths include a smaller skin incision, single-step dilation and sheath placement, good working access for pediatric instruments, variable length, and lower cost. In addition, the hypothesized decrease in renal and body wall trauma may result in less pain, reduced severity or risk of complications, and shorter hospital stays including the possibility of performing 'tubeless' outpatient PCNLs. Further study is needed to confirm these possibilities.

Original languageEnglish (US)
Pages (from-to)697-701
Number of pages5
JournalUrology
Volume52
Issue number4
DOIs
StatePublished - Oct 1 1998

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Percutaneous Nephrostomy
Preschool Children
Pediatrics
Dilatation
Outpatients
Morbidity
Kidney
Lithotripsy
Blood Vessels
Length of Stay
Hospitalization
Weights and Measures
Costs and Cost Analysis
Pain
Skin
Wounds and Injuries

ASJC Scopus subject areas

  • Urology

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Percutaneous nephrolithotomy in infants and preschool age children : Experience with a new technique. / Jackman, Stephen V.; Hedican, Sean P.; Peters, Craig A; Docimo, Steven G.

In: Urology, Vol. 52, No. 4, 01.10.1998, p. 697-701.

Research output: Contribution to journalArticle

Jackman, Stephen V. ; Hedican, Sean P. ; Peters, Craig A ; Docimo, Steven G. / Percutaneous nephrolithotomy in infants and preschool age children : Experience with a new technique. In: Urology. 1998 ; Vol. 52, No. 4. pp. 697-701.
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abstract = "Objectives. To develop a less invasive method for performing percutaneous nephrolithotomy (PCNL) with the intent of decreasing the morbidity of the procedure in young children. Methods. A novel percutaneous renal access technique ('mini-perc') was developed using an 11F peel-away vascular access sheath. Tract dilation and insertion of the sheath into the collecting system was performed with a single pass over an access wire. PCNL was performed using pediatric instruments and electrohydraulic lithotripsy. Sheath design improvements were implemented that make it specific for pediatric PCNL. Results. Eleven procedures have been performed with the 11F sheath. Patient age ranged from 2 to 6 years (mean 3.4) and weight from 5 to 24 kg (mean 12.5). The average stone burden was 1.2 cm2. Mean procedure time, estimated blood loss, and length of hospitalization were 203 minutes, 25 mL, and 6 days, respectively. Six (85{\%}) of 7 patients are currently stone free with an average follow-up of 12 weeks. No patient required transfusion, developed urosepsis, or had a procedure-related complication. One procedure was performed in an outpatient setting with no postoperative nephrostomy tube. Conclusions. The 11F 'mini-perc' technique was successful in rendering 85{\%} of patients stone free with minimal morbidity. Its advantages over obtaining acceSS with standard 24 to 34F access sheaths include a smaller skin incision, single-step dilation and sheath placement, good working access for pediatric instruments, variable length, and lower cost. In addition, the hypothesized decrease in renal and body wall trauma may result in less pain, reduced severity or risk of complications, and shorter hospital stays including the possibility of performing 'tubeless' outpatient PCNLs. Further study is needed to confirm these possibilities.",
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