HİLMİ UMUT ÜNAL, Hakan ERÇİL, Ferhat ORTOĞLU, Ergun ALMA, Sabahattin CEBER, Durmuş Alparslan DEMİRCİ, Yalçın Kaya EVLİYAOĞLU, Zafer Gökhan GÜRBÜZ

Pediatrik hastalarda mini perkütan nefrolitotomi deneyimlerimiz

Amaç: Bu çalışmada kliniğimizde böbrek taşı sebebi ile Mini-perkütan nefrolitotomi (Mini-PCNL) yaptığımız pediatrik yaş grubundaki hastaların değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Haziran 2009 ve Ocak 2016 tarihleri arasında kliğimizde böbrek taşı sebebi ile Mini- PCNL yaptığımız pediatrik yaş grubundaki (

Our experience with mini percutaneous nephrolithotomy in pediatric patients

Aim: The aim of this study was to evaluate the outcome of pediatric mini-percutaneus nephrolitotomy (Mini-PCNL). Material and Methods: The data of pediatric patients (<16 years) with kidney stones between June 2009 and January 2016 had been retrospectively reviewed. All patients were selected for Mini-PCNL according to European Association of Urology guidelines. The final treatment modality was decided with parents or heir-at-law. All patients were evaluated with noncontrast computerized tomography, kidney-ureter-bladder x-ray and/or ultrasonograpy prior to treatment. Results: A total of 60 patients (20 females, 40 males) with a mean age 9.3±4.53 (range;1-16) has been evaluated. The mean number of stones were 1.4±0.83 adet (1-5) and 28 of the stones were in right kidney and 32 of the stones were in left kidney. The mean stone-burden was 394.8±223.4 (range; 143-1350) mm2. The preoperative mean BUN, creatinine, hematocrite levels were 22.7±6.2 (12-39) mg/dL, 0.74±0.37 (0.3-3) mg/dL, % 35.42±2.64 (29-40), respectively. The mean flouroscopy time was 116.3±45.4 (40-234) seconds.The success rate was found 91.7 %. The minor and major complication rate were 11.6 %, 1.6 % respectively. Conclusion: The Mini-PCNL for pediatric kidney stones can be performed with higher success rates and low complications due to carefully selected cases and clinical experience.

PDF

___

1. Ost MC, Schneck FX.Peadiatric urology; peadiatric stone dissease treatment. Campbell’sUrology.Wein AJ, Kavous- siLR, Novick AC, Partin AW, Peters CA.Philadelphia: W.B. Saunders 2012; p: 3667-3684.
2. Hulbert JC, Reddy PK, Gonzales R, et al. Percutaneous nephrolithotomy: An alternative approach to the manage- ment of pediatric calculus disease. Pediatrics 1985;76: 610- 14.
3. Dwyer ME, Krambeck AE, Bergstralh EJ, et al. Temporalt- rends in incidence of kidney stones among children: a 25- year population based study. J Urol 2012;188:247-52.
4. Newman DM, Coury T, Lingeman JE, et al. Extracorpo- real shock wave lithotripsy experience in children. J Urol 1986;136:238-40.
5. Kroovand RL. Pediatric urolithiasis. Urol Clin North Am 1997;24:173.
6. Ganpule AP, Mishra S, Desai MR. Percutaneous neph- rolithotomy for pediatric urolithiasis. Indian J Urol 2010;26:549-54.
7. Puppo P. Percutaneous nephrolithotripsy. Curr OpinUrol 1999;9:325-8.
8. Woodside JR, Stevens GF, Stark GL, et al. Percutaneous sto- ne removal in children. J Urol 1985;134:1166-7.
9. Helal M, Black T, Lockhart J, Figueroa TE. The Hickman peel away sheath: alternative for pediatric percutaneous nephrolithotomy. J Endourol 1997;11:171-2.
10. Jackman SV, Docimo SG, Cadeddu JA, Bishoff JT, Kavoussi LR, Jarrett TW. The “mini-perc” technique: a less invasive alternative to percutaneous nephrolithotomy. World J Urol 1998;16:371-4.
11. Jackman SV, Hedican SP, Peters CA, Docimo SG. Per- cutaneous nephrolithotomy in infants and preschool age children: experienc ewith a new technique. Urology 1998;52:697-701.
12. Preminger GM, Assimos DG, Lingeman JE, et al; AUA Nephrolithiasis Guideline Panel. Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treat- ment recom-mendations. J Urol 2005;173:1991-2000.
13. Turk C, Knoll T, Petrik A, Sarica K: Guidelines on urolit- hiasis. European Association of Urology 2014 http://www. uroweb.org/publications/eau-guidelines
14. Badawy AA, Saleem MD, AbolyosrA, et al. Extra corpore- al shock wave lithotripsy as firstline treatment for urinary tract stones in children: outcome of 500 cases. Int Urol Nephrol 2012;44:661–6.
15. Penn HA, DeMarco RT, Sherman AK, Gatti JM, Murphy JP.Extracorporeal shock wave lithotripsy for renal calculi. J Urol 2009;182:1824–7.
16. Boormans JL, Scheepe JR, Verkoelen CF, VerhagenPC. Percutaneous nephrolithotomy for treating renal calculi in children. BJU Int 2005;95:631-4.
17. Nouralizadeh A, Basiri A, Javaherforooshzadeh A, Soltani MH, Tajali F. Experience of percutaneous nephrolithotomy using adult-size instruments in children less than 5 years old. J Pediatr Urol 2009;5:351-4.
18. Zeren S, Satar N, Bayazit Y, Bayazit AK, Payasli K, Ozkeçeli R. Percutaneous nephrolithotomy in the management of pediatric renal calculi. J Endourol 2002;16:75-8.
19. Salah MA, Tóth C, Khan AM, Holman E. Percutaneous nephrolithotomy in children: Experience with 138 cases in a developing country. World J Urol 2004;22:277-80.
20. Zeng G, Zhao Z, Wan S, Zhong W, Wu W. Comparision of children versus adults undergoing mini-percutaneous nephrolithotomy: large-scale analysis of a single institution. PloSOne 2013; 24;8:e66850.
21. Karatag T, Tepeler A, Silay MS, et al. A Comprasion of 2 Percutaneous Nephrolithotomy Techniques for the Treat- ment of Pediatric Kidney Stones of Sizes 10-20 mm: Micro- percvs Miniperc. Urology 2015;85:1015-8.
22. Hatipoglu NK, Tepeler A, Buldu I, et al. Initialexperience of micropercutaneous nephrolithotomy in the treatment of renal calculi in 140 renal units. Urolithiasis 2014;42:159-64.
23. Silay MS, Tepeler A, Atis G, et al. Initial report of microperc in the treatment of pediatric nephrolithiasis. J Pediatr Surg 2013;48:1578-83.
24. Ferakis N, Stavropoulus M. Mini percutaneous nephrolit- hotomy in the treatment of renal and upper ureteral stones: Lessons learned from a review of the literature. Urol Ann 2015;7:141-8.
25. Özden E, Şahin A, Tan B, Doğan HS, Eren MT, Tekgül S. Percutaneous renal surgery in children with complex stone. J Pediatr Urol 2008;4:295-8.
26. Lee WJ, Smith AD, Cubbeli V, et al.Percutaneous nephro- lithotomy: analysis of 500 consecutivecases. Urol Radiol 1986;8:61–6.
27. Sahin A, Tekgul S, Erdem E, Ekici S, Hascicek M, Kendi S .Percutaneous nephrolithotomy in older children. J Pediatr Surg 2000;35:1336–8.