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A Novel Surgical Technique for Treatment of Renal Stones in Preschool-aged Patients: Initial Experience With Needle-perc

  • Bo Xiao
    Affiliations
    Department of Urology, Beijing Tsinghua Changgung Hospital Affiliated With Tsinghua University, Tsinghua University Clinical Institute, Beijing, China
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  • Xiaolin Diao
    Affiliations
    Department of Medicine, Peking University Hospital, Beijing, China
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  • Song Jin
    Affiliations
    Department of Urology, Beijing Tsinghua Changgung Hospital Affiliated With Tsinghua University, Tsinghua University Clinical Institute, Beijing, China
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  • Chaoyue Ji
    Affiliations
    Department of Urology, Beijing Tsinghua Changgung Hospital Affiliated With Tsinghua University, Tsinghua University Clinical Institute, Beijing, China
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  • Gang Zhang
    Affiliations
    Department of Urology, Beijing Tsinghua Changgung Hospital Affiliated With Tsinghua University, Tsinghua University Clinical Institute, Beijing, China
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  • Boxing Su
    Affiliations
    Department of Urology, Beijing Tsinghua Changgung Hospital Affiliated With Tsinghua University, Tsinghua University Clinical Institute, Beijing, China
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  • Yuzhe Tang
    Affiliations
    Department of Urology, Beijing Tsinghua Changgung Hospital Affiliated With Tsinghua University, Tsinghua University Clinical Institute, Beijing, China
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  • Jianxing Li
    Correspondence
    Address correspondence to: Jianxing Li, Professor, Department of Urology, Beijing Tsinghua Changgung Hospital Affiliated With Tsinghua University, Tsinghua University Clinical Institute, No. 168, Litang Road, Changping District, Beijing, 102218, China.
    Affiliations
    Department of Urology, Beijing Tsinghua Changgung Hospital Affiliated With Tsinghua University, Tsinghua University Clinical Institute, Beijing, China
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      Objective

      To describe and evaluate our newly developed minimal instrumentation technique, needle-perc, for treatment of preschool-aged patients with renal stones. To the best of our knowledge, this is the smallest endoscopic equipment for percutaneous nephrolithotomy reported thus far.

      Materials and Methods

      Needle-perc was performed in 8 patients using a 4.2-Fr needle to achieve access to the collecting system under ultrasonic guidance alone. The mean patient age was 2.4 years (range, 0-5 years). Five of the 8 patients were boys, while 3 were girls. Six patients had unilateral stones and 2 patients had bilateral stones. Six renal units exhibited single calculus, 2 exhibited staghorn stones, and 2 exhibited multiple stones. The mean calculus size was 1.6 cm (range, 0.8-4.5 cm). Preoperative, intraoperative, and postoperative parameters were analyzed prospectively.

      Results

      Access was successfully achieved in all patients. Puncturing was fully guided by ultrasound. Five patients underwent needle-perc alone. Two patients were transferred to 16-Fr access because of intrarenal infection and large stone burden. One patient underwent reduction of tract number. The mean operative time was 49.2 minutes (range, 22-75 minutes); mean hemoglobin loss was 5.2 g/L (range, 0-13.8 g/L). The mean postoperative hospital stay was 5 days (range, 3-7 days). Preplaced catheters were kept for 2-3 days to facilitate fragment discharge. Complications occurred in 2 patients: fever >38.5°C. The stone-free rate was 100% at 1 month postoperatively.

      Conclusion

      Our initial data indicate that needle-perc is feasible and safe for preschool-aged renal patients. Further studies are required to define its usefulness in treatment of larger stones.
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