title: The Hickman peel-away sheath: alternative for pediatric percutaneous nephrolithotomy.
abstract: Percutaneous nephrolithotomy presents a therapeutic challenge in children because of the disproportion between the sizes of the instruments and the kidneys. A technique for pediatric nephrolithotomy used on a 2-year-old female child is presented. The patient was born prematurely and developed kidney stones as a complication of furosemide therapy. She failed medical management with hydrochlorothiazide, and the stone did not disintegrate following extracorporeal shockwave lithotripsy (ESWL). A Chiba needle was used to access the renal collecting system percutaneously. Using a guidewire, sequential dilatation was performed to 16F. A 15F Hickman catheter introduction kit was then used, and the sheath was partially peeled away. A 10F pediatric cystoscope and grasper were inserted through the sheath to remove the stones. A 12F catheter was then placed through the sheath; the sheath was peeled away, and the catheter was left indwelling for 48 hours. No complications ensued. A postoperative nephrostogram showed free drainage and absence of residual stones. Utilization of the Hickman peel-away sheath constitutes an excellent alternative nephrolithotomy technique for children with stones unresponsive to more conservative treatment.
authors.affiliation: University of South Florida Health Sciences Center, Tampa, USA.
authors.forename: M
authors.initials: M
authors.lastname: Helal
authors.forename: T
authors.initials: T
authors.lastname: Black
authors.forename: J
authors.initials: J
authors.lastname: Lockhart
authors.forename: T E
authors.initials: TE
authors.lastname: Figueroa
mesh_terms: D002408:Catheters, Indwelling; D002675:Child, Preschool; D003558:Cystoscopy / Q000379:methods; D004232:Diuretics / Q000009:adverse effects; D005260:Female; D005665:Furosemide / Q000009:adverse effects; D006801:Humans; D007669:Kidney Calculi / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000628:therapy*; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation / Q000379:methods*; D011859:Radiography
chemical_list: D004232:Diuretics; D005665:Furosemide