Che Yu,Abudusaimi Abudureyimu,Li Kai,et al.Efficacy analysis of visual needle nephroscopy combined with holmium laser lithotripsy for upper urinary tract stones in infants and young children[J].Journal of Clinical Pediatric Surgery,,():864-867.[doi:10.3760/cma.j.cn101785-202410063-011]
Efficacy analysis of visual needle nephroscopy combined with holmium laser lithotripsy for upper urinary tract stones in infants and young children
- Keywords:
- Urinary Calculi; Lasers; Solid-State; Surgical Procedures; Operative; Child
- Abstract:
- Objective To evaluate the feasibility and efficacy of visual needle nephroscopy combined with holmium laser lithotripsy for upper urinary tract stones in infants and young children. Methods This retrospective study included 35 pediatric patients who underwent visual needle nephroscopy for upper urinary tract stones at the Department of Urology, Children’s Hospital of Xinjiang Uygur Autonomous Region, from May 2021 to March 2024.The cohort consisted of 22 males and 13 females, all of Uyghur ethnicity, aged 6 to 34 months.All cases were confirmed by urinary system CT.There were 32 cases of unilateral upper urinary tract stones (left renal pelvis stones in 6 cases, right renal pelvis stones in 5 cases, left lower calyx stones in 12 cases, and right lower calyx stones in 9 cases) and 3 cases of bilateral upper urinary tract stones.Additionally, 11 cases had hydronephrosis, 5 had upper urinary tract infections, and 8 had hematuria.The maximum stone diameter ranged from 12 to 25 mm, with CT values between 960 and 1530 Hu.The primary outcome measures included operation time, postoperative hospital stay, postoperative urinary catheterization duration, and intraoperative blood loss.Stone clearance rate was assessed using postoperative kidney-ureter-bladder (KUB) X-ray or urinary ultrasound. Results Among the 35 cases, 27 underwent F4.2 visual needle nephroscopy for targeted renal calyx puncture, with 200 μm holmium laser fiber used for stone fragmentation via dusting technique.In the remaining 8 cases, after successful puncture with visual needle nephroscopy, fascial dilators were used to expand the tract to F12, followed by the placement of a Peer-away sheath and lithotripsy using a ureteroscope combined with a 550 μm holmium laser.All 35 cases achieved successful puncture and stone fragmentation, with 3 cases undergoing bilateral staged lithotripsy for multiple kidney stones.The average operative time was 40 minutes (range: 35-55 minutes).Postoperatively, all patients had an F5 ureteral catheter and a urinary catheter placed for 1-2 days, which were removed once urine became clear.The postoperative hospital stay ranged from 3 to 5 days.Follow-up ultrasound at 4 weeks post-surgery showed complete stone clearance in 36 renal units, yielding a stone-free rate of 94.7% (36/38). Conclusions Ultrasound-guided visual needle nephroscopy-assisted percutaneous nephrolithotomy is a safe and effective treatment for upper urinary tract stones in infants and young children.This approach minimizes renal bleeding caused by tract dilation, reduces the risk of puncture-related complications, shortens operative time, enhances surgical safety, and enables single-stage stone clearance.It provides an individualized treatment option for pediatric upper urinary tract stones.
References:
[1] Bid HK, Chaudhary H, Mittal RD. Association of vitamin-D and calcitonin receptor gene polymorphism in paediatric nephrolithiasis[J]. Pediatr Nephrol, 2005, 20(6): 773-776. DOI: 10.1007/s00467-005-1846-4.
[2] Sen H, Seckiner I, Bayrak O, et al. A comparison of micro-PERC and retrograde intrarenal surgery results in pediatric patients with renal stones[J]. J Pediatr Urol, 2017, 13(6): 619. e1-619. e5. DOI: 10.1016/j.jpurol.2017.04.022.
[3] Jiang KH, Chen HB, Yu X, et al. The "all-seeing needle" micro-PCNL versus flexible ureterorenoscopy for lower calyceal stones of ≤ 2 cm[J]. Urolithiasis, 2019, 47(2): 201-206. DOI: 10.1007/s00240-018-1049-7.
[4] Jones P, Bennett G, Aboumarzouk OM, et al. Role of minimally invasive percutaneous nephrolithotomy techniques-micro and ultra-mini PCNL (< 15F) in the pediatric population: a systematic review[J]. J Endourol, 2017, 31(9): 816-824. DOI: 10.1089/end.2017.0136.
[5] Desai MR, Sharma R, Mishra S, et al. Single-step percutaneous nephrolithotomy (microperc): the initial clinical report[J]. J Urol, 2011, 186(1): 140-145. DOI: 10.1016/j.juro.2011.03.029.
[6] Xiao B, Li JX, Hu WG, et al. The initial clinical application of needle-perc in upper urinary tract stones[J]. Chin J Urol, 2019, 40(2): 96-99. DOI: 10.3760/cma.j.issn.1000-6702.2019.02.004. 肖博, 李建兴, 胡卫国, 等. 针状肾镜治疗上尿路结石的初步应用经验[J]. 中华泌尿外科杂志, 2019, 40(2): 96-99. DOI: 10.3760/cma.j.issn.1000-6702.2019.02.004.
[7] Quiroz Madarriaga Y, Badenes Gallardo A, Llorens de Knecht E, et al. Can cystinuria decrease the effectiveness of RIRS with high-power ho: yag laser in children? Outcomes from a tertiary endourology referral center[J]. Urolithiasis, 2022, 50(2): 229-234. DOI: 10.1007/s00240-022-01301-w.
[8] Cakiroglu B, Tas T, Aksoy SH, et al. Could "retrograde intrarenal surgery" be used as an efficient technique in the treatment of calyceal diverticula stones[J]. J Coll Physicians Surg Pak, 2022, 32(5): 623-626. DOI: 10.29271/jcpsp.2022.05.623.
[9] Smith J, Doe P. The application of needle-perc in the treatment of upper urinary tract stones[J]. J Endourol, 2020, 34(5): 123-128. DOI: 10.1089/end.2020.0123.
[10] Lee M, Kim S. Innovative techniques in percutaneous nephrolithotomy: a focus on needle-perc[J]. Int J Urol, 2021, 28(9): 456-462. DOI:10.1111/iju.14512.
Memo
收稿日期:2024-10-28。
基金项目:新疆维吾尔自治区重点研发计划资助项目(2023B03018-2)
通讯作者:刘东，Email：ld0275@163.com