Minimally invasive percutaneous nephrolithotomy in preschool age children with kidney calculi (including stones induced by melamine-contaminated milk powder).
OBJECTIVE
This study was undertaken to assess the safety and efficacy of minimally invasive percutaneous nephrolithotomy (mini-PCNL) using ureteroscope and pneumatic intracorporeal lithotripsy in preschool age children with kidney calculi.


METHODS
We studied 27 renal units in 20 patients of preschool age (≤ 6 years) who underwent mini-PCNL at our institute. The mean age was 42.6 months (range 14-68 months). The average stone burden was 1.85 cm (range 0.9-2.8 cm). Eight patients aged 14 to 58 months had been exposed to melamine-tainted powdered formula. The mini-PCNL was performed with an X-ray-guided peripheral puncture. Minimal tract dilatation was undertaken to fit a 14-16 Fr peel-away sheath. Ureteroscope and pneumatic intracorporeal lithotripsy were used to fragment the stones.


RESULTS
Complete clearance was achieved in 23 renal units (85.2 %) with mini-PCNL monotherapy. This has increased to 92.6 % after adjunctive ESWL. The average fall in hemoglobin was 1.28 g/dL. None of the patients required blood transfusion. The median length of hospital stay was 8.2 days. Patients were followed up every 6 months for 2 years. There has been only one recurrence of stone and no long-term complications.


CONCLUSIONS
Mini-PCNL is a effective treatment for pediatric kidney stones refractory to extracorporeal shock wave lithotripsy, including stones induced by melamine-contaminated milk powder. The "mini-PCNL" technique, which uses ureteroscope and pneumatic intracorporeal lithotripsy, is a safe and feasible modality for treating renal calculi in preschool age children.
Department of Urology, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, 210008, China.
Xiang
X
Yan
Samih
S
Al-Hayek
Weidong
W
Gan
Wei
W
Zhu
Xiaogong
X
Li
Hongqian
H
Guo
D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000737:chemistry / Q000494:pharmacology*; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D011860:Radiography, Abdominal; D012117:Resins, Synthetic; D012189:Retrospective Studies; D016896:Treatment Outcome; D014227:Triazines / Q000009:adverse effects* / Q000032:analysis; D018666:Ureteroscopy / Q000379:methods*
D012117:Resins, Synthetic; D014227:Triazines; C011907:melamine