Microperc for Pediatric Nephrolithiasis: Technique in Valdivia-Modified Position

Abstract

Introduction Micropercutaneous nephrolithotomy (microperc) has been recently proposed in adult patients. We present our initial experience in children using a modified technical approach.

Methods After the retrograde positioning of a 5F catheter, a 4.85F metallic needle (1.9 mm) was used for direct percutaneous calyceal access under ultrasonographic and fluoroscopic guidance with the patient in supine Valdivia-modified position. Once a three-way connector was inserted to the needle, stone fragmentation was performed under direct vision using a 200 μm holmium:YAG laser fiber and a 0.9-mm high-resolution (10,000 pixels) optic flexible wire connected with the telescope, with intermittent saline infusion. The transureteral catheter was removed within 18 to 24 hours.

Results A total of five patients aged 18 months to 11 years (mean, 5.8 years) received microperc lithotripsy in a 6-month period. The mean stone size was 15.0 mm (±2.5 mm). Conversion to retrograde intrarenal surgery was necessary in one case, due to stone migration and poor visibility. Moderate hydronephrosis was present in one kidney. The mean operative time was 56 minutes (±23 minutes). The blood loss was insignificant (< 0.6 Hbg/dL) and postoperative discomfort was minimal. The mean hospital stay was 2.4 ± 0.6 days for four patients after the removal of ureteral catheter. The JJ stent was removed after 15 days in the last patient. The overall stone-free rate at 1 month was 100% and no ancillary procedures were required.

Conclusions Microperc is a new cost-effective and time-saving technique that we demonstrated as safe and effective in minimally invasive procedure for lower pole and pelvic renal stones of small size. Indications and limits should be defined by multicenter randomized studies, comparing the former procedures.

Keywords

microperc - nephrolithiasis - percutaneous nephrolithotomy - children - Valdivia position

• References

• 1 Caione P, Matarazzo E, Battaglia S. Stone treatment in children: where we are today?. Arch Ital Urol Androl 2010; 82 (1) 45-48
• 2 Unsal A, Resorlu B, Kara C, Bozkurt OF, Ozyuvali E. Safety and efficacy of percutaneous nephrolithotomy in infants, preschool age, and older children with different sizes of instruments. Urology 2010; 76 (1) 247-252
• 3 Salerno A, Nappo SG, Matarazzo E, De Dominicis M, Caione P. Treatment of pediatric renal stones in a Western country: a changing pattern. J Pediatr Surg 2013; 48 (4) 835-839
• 4 D'Addessi A, Bongiovanni L, Racioppi M, Sacco E, Bassi P. Is extracorporeal shock wave lithotripsy in pediatrics a safe procedure?. J Pediatr Surg 2008; 43 (4) 591-596
• 5 Unsal A, Resorlu B. Retrograde intrarenal surgery in infants and preschool-age children. J Pediatr Surg 2011; 46 (11) 2195-2199
• 6 Childs MA, Rangel LJ, Lingeman JE, Krambeck AE. Factors influencing urologist treatment preference in surgical management of stone disease. Urology 2012; 79 (5) 996-1003
• 7 Desai M, Mishra S. 'Microperc' micro percutaneous nephrolithotomy: evidence to practice. Curr Opin Urol 2012; 22 (2) 134-138
• 8 Bader MJ, Gratzke C, Seitz M, Sharma R, Stief CG, Desai M. The “all-seeing needle”: initial results of an optical puncture system confirming access in percutaneous nephrolithotomy. Eur Urol 2011; 59 (6) 1054-1059
• 9 Desai MR, Sharma R, Mishra S, Sabnis RB, Stief C, Bader M. Single-step percutaneous nephrolithotomy (microperc): the initial clinical report. J Urol 2011; 186 (1) 140-145
• 10 Sabnis RB, Ganesamoni R, Ganpule AP , et al. Current role of microperc in the management of small renal calculi. Indian J Urol 2013; 29 (3) 214-218
• 11 Tepeler A, Armagan A, Sancaktutar AA , et al. The role of microperc in the treatment of symptomatic lower pole renal calculi. J Endourol 2013; 27 (1) 13-18
• 12 Sabnis RB, Ganesamoni R, Doshi A, Ganpule AP, Jagtap J, Desai MR. Micropercutaneous nephrolithotomy (microperc) vs retrograde intrarenal surgery for the management of small renal calculi: a randomized controlled trial. BJU Int 2013; 112 (3) 355-361
• 13 Silay MS, Tepeler A, Atis G , et al. Initial report of microperc in the treatment of pediatric nephrolithiasis. J Pediatr Surg 2013; 48 (7) 1578-1583
• 14 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240 (2) 205-213
• 15 Valdivia Uría JG, Valle Gerhold J, López López JA , et al. Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol 1998; 160 (6 Pt 1) 1975-1978
• 16 Ibarluzea G, Scoffone CM, Cracco CM , et al. Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int 2007; 100 (1) 233-236
• 17 Türk C, Knall T, Petrik A , et al. EAU Guidelines on Urolithiasis. 2011 . Available at: http://www.uroweb.org/guidelines/online-guidelines/ . Accessed February 20, 2012
• 18 Akman T, Binbay M, Sari E , et al. Factors affecting bleeding during percutaneous nephrolithotomy: single surgeon experience. J Endourol 2011; 25 (2) 327-333
• 19 Goyal NK, Goel A, Sankhwar SN , et al. A critical appraisal of complications of percutaneous nephrolithotomy in paediatric patients using adult instruments. BJU Int 2014; 113 (5) 801-810
• 20 Hatipoglu NK, Sancaktutar AA, Tepeler A , et al. Comparison of shockwave lithotripsy and microperc for treatment of kidney stones in children. J Endourol 2013; 27 (9) 1141-1146
• 21 Granberg CF, Baker LA. Urolithiasis in children: surgical approach. Pediatr Clin North Am 2012; 59 (4) 897-908