Minimally invasive percutaneous nephrolithotomy in preschool age children with kidney calculi (including stones induced by melamine-contaminated milk powder)

Purpose

This study was undertaken to assess the safety and efficacy of minimally invasive percutaneous nephrolithotomy (mini-PCNL) using ureteroscope and pneumatic intracorporeal lithotripsy in preschool age children with kidney calculi.

Methods

We studied 27 renal units in 20 patients of preschool age (≤6?years) who underwent mini-PCNL at our institute. The mean age was 42.6?months (range 14–68?months). The average stone burden was 1.85?cm (range 0.9–2.8?cm). Eight patients aged 14 to 58?months had been exposed to melamine-tainted powdered formula. The mini-PCNL was performed with an X-ray-guided peripheral puncture. Minimal tract dilatation was undertaken to fit a 14–16?Fr peel-away sheath. Ureteroscope and pneumatic intracorporeal lithotripsy were used to fragment the stones.

Results

Complete clearance was achieved in 23 renal units (85.2?%) with mini-PCNL monotherapy. This has increased to 92.6?% after adjunctive ESWL. The average fall in hemoglobin was 1.28?g/dL. None of the patients required blood transfusion. The median length of hospital stay was 8.2?days. Patients were followed up every 6?months for 2?years. There has been only one recurrence of stone and no long-term complications.

Conclusion

Mini-PCNL is a effective treatment for pediatric kidney stones refractory to extracorporeal shock wave lithotripsy, including stones induced by melamine-contaminated milk powder. The “mini-PCNL” technique, which uses ureteroscope and pneumatic intracorporeal lithotripsy, is a safe and feasible modality for treating renal calculi in preschool age children.