title: Mini-percutaneous Nephrolithotomy Under Total Ultrasonography in Patients Aged Less Than 3 Years: A Single-center Initial Experience from China.
abstract: BACKGROUND
  Urolithiasis in pediatric population is a serious problem with the incidence increased these years. In the management of larger stones (diameters >2 cm), percutaneous nephrolithotomy (PCNL) is considered to be the gold standard. This study aimed to investigate the efficacy and safety of mini-PCNL under total ultrasonography in patients aged <3 years.
  
  
  METHODS
  We reviewed 68 patients (80 renal units) aged <3 years between August 2006 and December 2014 in Peking University People's Hospital and Beijing Tsinghua Changung Hospital, including 36 renal units with a single stone, 6 with staghorn stones, 14 with upper ureteral stones, and 24 with multiple stones. The mean age of the patients was 24.2 months (range 6-36 months), and the mean maximum stone diameter was 19.2 mm (range 10-35 mm). The puncture site selection and tract dilation were guided by Doppler ultrasonography solely. All procedures were performed using 12-16 Fr tracts. Stones were fragmented using pneumatic lithotripsy and a holmium laser with an 8/9.8 Fr rigid ureteroscope.
  
  
  RESULTS
  Fifty-six patients with unilateral stones underwent a single session procedure, and 12 patients with bilateral stones underwent two procedures. The mean time to establish access was 2.8 min (range 1.8-5.0 min), the mean operative time was 36.5 min (range 20-88 min), the mean decrease in hemoglobin concentration was 8.9 g/L (2-15 g/L), and the stone-free rate (SFR) at hospital discharge was 94.0%. The mean postoperative hospital stay was 7.1 days (range 3-13 days). Postprocedure complications included fever (>38.5°C) in five patients and reactive pleural effusion in one patient. Blood loss requiring transfusion, sepsis, adjacent organ injury, and kidney loss were not observed.
  
  
  CONCLUSIONS
  This study indicated that ultrasound-guided mini-PCNL is feasible and safe in patients aged <3 years, without major complications or radiation exposure.
authors.forename: Bo
authors.initials: B
authors.lastname: Xiao
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.forename: Wei-Guo
authors.initials: WG
authors.lastname: Hu
authors.forename: Song
authors.initials: S
authors.lastname: Chen
authors.forename: Yu-Hong
authors.initials: YH
authors.lastname: Li
authors.forename: Yu-Zhe
authors.initials: YZ
authors.lastname: Tang
authors.forename: Yu-Bao
authors.initials: YB
authors.lastname: Liu
authors.affiliation: Department of Urology, Beijing Tsinghua Changung Hospital, Medical Center, Tsinghua University, Beijing 102218, China.
authors.forename: Jian-Xing
authors.initials: JX
authors.lastname: Li
mesh_terms: D002675:Child, Preschool; D002681:China; D005260:Female; D006801:Humans; D007223:Infant; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*; D014514:Ureteral Calculi / Q000000981:diagnostic imaging / Q000601:surgery*