title: Ultramini nephrostomy tract combined with flexible ureterorenoscopy for the treatment of multiple renal calculi in paediatric patients.
abstract: OBJECTIVE
  To assess the safety and efficacy of an ultramini nephrostomy tract, which we were using for the first time, combined with flexible ureterorenoscopy (URS) in the treatment of pediatric patients with multiple renal calculi.
  
  
  METHODS
  Twenty pediatric patients (age, ≤ 6 years) underwent ultramini percutaneous nephrolithotomy (PCNL) combined with flexible URS. The group had multiple renal calculi, which were bilateral in 3 cases and were located in a total of 23 sites. The calculi were located in 2 calyces in 10 cases, scattered in more than 2 calyces in 7 cases, and limited to 1 calyx in 3 cases. The average patient age was 37.35 months (range, 14-68 months). The average stone diameter was 2.0 cm (range, 1-3.0 cm). In all patients, an ultramini nephrostomy tract was established under ultrasound guidance (dilated to F10) with simultaneous sheath placement. The flexible URS was placed into the collecting system during holmium laser lithotripsy.
  
  
  RESULTS
  When ultramini PCNL was combined with flexible ureterorenoscopic holmium laser lithotripsy, the complete stone-free rate was 87% (20/23). The average level of hemoglobin decreased to 1.0 g/dL after the operation. No blood transfusions were needed. Levels of blood urea nitrogen, creatinine, and C-reactive protein were not significantly different before and after the operation. The average duration of hospitalization was approximately 4.85 days, and all cases were followed up for 6 to 12 months. No complications were found.
  
  
  CONCLUSIONS
  Ultramini PCNL combined with flexible ureterorenoscopic holmium laser lithotripsy is a safe and effective treatment for children with multiple renal calculi.
authors.affiliation: Department of Urology, Affiliated Hospital of Hebei University, Baoding, China.
authors.forename: Jingyang
authors.initials: J
authors.lastname: Guo
authors.affiliation: Department of Urology, Affiliated Hospital of Hebei University, Baoding, China.
authors.forename: Wen Zeng
authors.initials: WZ
authors.lastname: Yang
authors.affiliation: Department of Urology, Affiliated Hospital of Hebei University, Baoding, China.
authors.forename: Yanqiao
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Urology, Affiliated Hospital of Hebei University, Baoding, China.
authors.forename: Feng
authors.initials: F
authors.lastname: An
authors.affiliation: Department of Urology, Affiliated Hospital of Hebei University, Baoding, China.
authors.forename: Ruojing
authors.initials: R
authors.lastname: Wei
authors.affiliation: Department of Urology, Affiliated Hospital of Hebei University, Baoding, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Urology, Affiliated Hospital of Hebei University, Baoding, China.
authors.forename: Haisong
authors.initials: H
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000473:pathology / Q000601:surgery* / Q000648:ultrastructure; D007902:Length of Stay / Q000706:statistics & numerical data; D017602:Lithotripsy, Laser / Q000379:methods; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods; D018666:Ureteroscopy / Q000379:methods*; D055815:Young Adult
keywords: Kidney calculi; Lithotripsy; Pediatrics; Percutaneous nephrolithotomy; Ureteroscopy