Factors affecting complication rates of retrograde flexible ureterorenoscopy: analysis of 1571 procedures-a single-center experience.

PURPOSE: To evaluate the factors affecting complication rates of flexible ureteroscopy and laser lithotripsy (FURSL). MATERIALS AND METHODS: Data on a total of 1395 patients, with 1411 renal units underwent 1571 procedures with FURSL for renal and/or proximal ureteral stones between April 2012 and January 2016, were retrospectively analyzed. Complications were assessed using the Satava and modified Clavien systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. RESULTS: The mean patient age in the total procedures was 45.68 ± 14.00 years (range 2-86 years), and the mean stone size was 15.15 ± 8.32 mm (range 5-75 mm). The overall success rate was 95.6 %. A total of 209 (13.3 %) cases suffered from complications with intraoperative complications rates of 5.9 % and postoperative complication rates of 7.3 %. Univariate analysis revealed no significant difference in complication rates in respect of age, gender, body mass index, use of ureteral access sheath, operation time, bleeding disorder, solitary kidney, preoperative stenting, American Society of Anesthesiologists score, repeated procedure or location of stones (all p value >0.05). Complication rates were determined to be significantly affected by stone size (p = 0.026), multiplicity (p = 0.028) and the presence of congenital renal abnormality (p < 0.01). The only significant factor in multivariate analysis was the presence of congenital renal abnormalities (p = 0.02). CONCLUSIONS: The results of the current study indicated that stone size, stone number and the presence of congenital renal abnormalities were factors affecting complication rates after FURSL, although congenital renal abnormality was the only independent predictor among these risk factors.

Potential biomarkers for the early detection of acute kidney injury after percutaneous nephrolithotripsy.

This study aims to investigate the role of urinary biomarkers in the determination of the potential risks of renal parenchymal tubular damage in adult patients who underwent percutaneous nephrolithotomy (PNL) with the indication of renal stone. A randomized and prospective controlled study was performed between June and December 2013. We enrolled 29 consecutive patients with renal calculi > 2 cm and who underwent PNL, as well as 47 healthy control subjects. Urine samples, including 2 h before surgery, 2 and 24 h after surgery were collected from the patient group. Freshly voided urine samples were collected from the control group. Kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-glucosaminidase (NAG), and liver-type fatty acid binding protein (LFABP) levels were measured from these urine samples. The mean KIM-1/Cr value that measured 24 h after the operation was statistically significant, higher than its preoperative (preop) level (p = 0.045). A significant difference was detected between the mean preop and postoperative (postop) 24 h NAG/Cr values (p < 0.001). Also, postop 24 h NGAL/Cr levels were statistically significant, higher than its preop levels (p = 0.013). According to the comparison of preop and postop levels, an increase in LFABP/Cr values secondary to surgical intervention was observed without any statistically significant difference. Besides the LFABP/Cr levels do not change after percutaneous kidney surgery, KIM-1/Cr, NAG/Cr, and NGAL/Cr levels increase postop period, especially at 24 h. Further studies with a larger series and repeated measurements should be performed to clarify if they can be used to demonstrate renal damage after percutaneous surgery or not.

The effect of music therapy during shockwave lithotripsy on patient relaxation, anxiety, and pain perception.

OBJECTIVES: To research the effect of listening to music during shock wave lithotripsy (SWL) on the patient's pain control, anxiety levels, and satisfaction. PATIENTS AND METHODS: The study comprised 400 patients from three hospitals. Half of patients listened to music during their first SWL session but not during their second session. The other half had no music for the first session but the second session was accompanied by music. During all sessions, with and without music, pulse rates, blood pressure, State-Trait Anxiety Inventory-State Anxiety scores (STAI-SA), Visual Analog Scale (VAS scores for pain), willingness to repeat procedure (0 = never to 4 happily), and patient satisfaction rates (0 = poor to 4 = excellent) were assessed. RESULTS: There was no statistical difference between the two groups in terms of blood pressure and pulse rates. In both groups, the STAI-SA and VAS pain scores were lower in the session when music was listened to (p < 0.001). The patients requested more SWL treatment be completed while listening to music and their satisfaction was greater. CONCLUSION: Music lowered the anxiety and pain scores of patients during SWL and provided greater satisfaction with treatment. Completing this procedure while the patient listens to music increases patient compliance greatly and reduces analgesic requirements.

Ultrasound-guided micropercutaneous nephrolithotomy in pediatric patients with kidney stones.

OBJECTIVE: To present the outcomes of ultrasound-guided micropercutaneous nephrolithotomy for the treatment of renal stones in pediatric patients. METHODS: Ultrasound-guided micropercutaneous nephrolithotomy was carried out on 25 pediatric patients from June 2012 to October 2014. Micropercutaneous nephrolithotomy surgery was completed without the use of fluoroscopy in 19 patients. Medical records were retrieved from our institutional database and retrospectively reviewed. Percutaneous puncture was carried out by an "all-seeing needle" in seven patients and by a 14-G intravenous cannula in 18 patients. After entering to the collecting system through an "all-seeing needle" or by Microsheath, the calculus was fragmented using a 273-micron holmium yttrium aluminium garnet laser. After the stone was fragmented to the smallest pieces possible, the operation was terminated. RESULTS: Single access was obtained in all patients using ultrasound guidance. The average age of the patients was 4.12 ± 5.33 years. The mean stone size was 13.45 ± 3.11 mm. The mean operative time was 51.45 ± 30.69 min. The mean duration of hospitalization was 3.18 ± 1.77 days. Treatment success was 92%. Two patients had residual fragments after the procedure; these patients were followed conservatively. A total of three minor complications were observed and all of them were managed conservatively. CONCLUSIONS: To our knowledge, this is the first study of ultrasound-guided micropercutaneous nephrolithotomy in the pediatric population. Our findings suggest that micropercutaneous nephrolithotomy can be safely carried out with ultrasound guidance in children by experienced hands, allowing to minimize risks associated with radiation exposure in this patient population.

The comparison of standard and tubeless percutaneous nephrolithotomy procedures.

PURPOSE: To compare totally tubeless and standard percutaneous nephrolitotomy procedures on many parameters. MATERIALS AND METHODS: Percutaneous nephrolitotomy was performed on 195 patients between June 2009 and May 2012. The data of those patients were evaluated retrospectively. Totally tubeless cases were enrolled to Group 1, and Group 2 consisted of non-tubeless cases (re-entry or Foley catheter). RESULTS: Group 1 included 85 cases and group 2 a total of 110 patients. Paper tracing values for the kidney stones were 321.25 ± 102.4 mm(2) and 324.10 ± 169.5 mm(2) respectively. Mean fluoroscopy time was 4.9 ± 1.9 min and 5.08 ± 2.7 min, mean operation time was 78.8 ± 27.9 min and 81.9 ± 28.77 min and mean decrease in hematocrit was 2.6 ± 1.6 and 3.74 ± 1.9 respectively. All these comparisons were statistically significant. Length of hospitalization was 1.6 ± 1.1 and 3.5 ± 1.5 days for Groups 1 and 2 respectively. Mean superficial pain score was 5.8 ± 1.6 and 6.7 ± 1.2 respectively for both groups after 1 hour. At 6 hours, the scores changed to 3.87 ± 1.22 and 4.84 ± 1.3 respectively. The analgesic dose was 1.00 ± 0.7 and 1.53 ± 0.6 for the groups respectively at 6 hours. All the statistical differences were significant for these three parameters. CONCLUSIONS: We believe that, because of their post operative patient comfort and decreased length of hospital stay, totally tubeless procedures should be considered as an alternative to standard percutaneous nephrolitotomy.

Treatment of complicated bladder rupture with novel percutaneous interventional treatment technique.

Bladder rupture (BR) is very rare and usually occurs after high-energy events. Although high success rates have been reported for surgical intervention, it has not been clearly stated in the literature what could be done in cases where surgery has been unsuccessful. In this case report, we aimed to demonstrate that we provided treatment with the novel interventional technique in our young patient whose urinary leakage and sepsis persisted despite repeated surgeries and prolonged nephrostomy catheter drainage.

Assessment of anti-sperm antibodies in couples after testicular sperm extraction.

PURPOSE: Testicular spermatozoa can be retrieved successfully by the testicular sperm extraction (TESE) procedure and used for intracytoplasmic sperm injection. Disruption in the blood-testis barrier can lead to the production of antisperm antibodies (ASA). The aim of this prospective study was to investigate the frequency of ASA formation in couples after TESE procedure. METHODS: Thirty-seven couples were included in the study at the Urology Clinic of the Dr. Zekai Tahir Burak Women's Health Training and Research Hospital. History, physical examination, spermiogram, and endocrine profiles were obtained for all male patients. All the male patients in this study had been diagnosed with nonobstructive azoospermia (NOA) and underwent microdissection TESE. Secondary and tertiary cases were also included in the study. Serum samples were obtained from all 74 patients before TESE, and at three and 12 months after TESE. Serum ASA levels were determined. ANOVA was performed for statistical analysis for serum Follicle-Stimulating Hormone (FSH), testosterone and testicular volume. P < 0.05 was considered significant. RESULTS: There were no differences in the testicular volumes, serum FSH and testosterone levels before and after TESE. None of the patients or their partners developed significant levels of ASA as a result of the TESE procedure. CONCLUSION: TESE procedure does not cause ASA production in either males or their female partners.

An examination on composition of spermatozoa obtained from pre-operative and post-operative varicocele patients.

Varicocele is one of the main and surgically repairable causes of male infertility, which arises from dilatation and torsion of the testicular veins in the plexus pampiniformis. In this study, we examined semen samples from 40 patients diagnosed with varicocele between the ages of 15 and 30 years, according to WHO criteria (pre-operatively, and at 3, 6, and 12 months post-operatively). The mean spermatozoa concentration was found to be 45.25 ± 34.83 million/ml pre-operatively, while the mean post-operative concentration was 48.85 ± 35.73 million/ml at three months, 51.72 ± 32.82 million/ml at six months, and 49.63 ± 28.05 million/ml at 12 months (P > 0.05). The mean rate of A + B motile spermatozoa was 35.5 ± 14.71% pre-operatively, 42.65 ± 16.80% at three months, 43 ± 13.52%at six months and 44 ± 14.76 percent at 12 months post-operatively (P < 0.05). The mean Kruger morphology score was 3.15 ± 3.0% pre-operatively, and 3.20 ± 2.83% at three months, 2.97 ± 2.61%at six months and 3.27 ± 2.50%at 12 months post-operatively (P > 0.05). The nucleus, acrosomal cap, mitochondrial structure and microtubules of the tail of the spermatozoa were examined under electron microscopy. The mean DNA fragmentation index (DFI%) of the spermatozoa was 20.57 ± 4.60% pre-operatively, and post-operatively at 17.27 ± 3.65% at three months, 15.5 ± 3.23% at six months and 15.3 ± 3.63% at 12 months (P < 0.001). The findings suggest that despite the increased count and motility, as well as the improved DNA fractures observed post-operatively in the spermatozoa of varicocele patients, the morphology rates remain intact.

Comparison of the results of pediatric percutaneous nephrolithotomy with different sized instruments.

We aim to compare the outcomes, including the morbidity and success rates in children undergoing percutaneous nephrolithotomy (PCNL) using different sized devices. According to the size of instruments used during surgery, three different groups (ultra-mini-PCNL, mini-PCNL and adult size PCNL) were composed and the outcomes were compared between the groups. PCNL was applied to 225 renal units of 220 children, including 5 patients with bilateral kidney stones. Percutaneous nephrolithotomy was performed using adult instruments (24 F) in 82 renal units, using pediatric instruments (18 F) in 89 and using minimal-size instruments (9.5 F) in 50. One-hundred and twenty-four girls and 96 boys with a mean age of 8.33 (<17) years were assessed. Stone-free rates were 78 % in group 1 (n = 39) using 9.5 F nephroscope, 75.8 % in group 2 (n = 69) using 18 F nephroscope and 71.4 % in group 3 (n = 60) using 24 F nephroscope. Time to access the collecting system, operative time, duration of nephrostomy and average postoperative hospital stay did not differ between the groups. However, mean hematocrit drop and stone burden were significantly lesser in ultra-mini-PCNL group. There was no significant difference in the complication rates between the groups, according to the modified Clavien classification system. As the important complication of PCNL, bleeding seems to be associated with diameter of dilatation, calibre of nephroscopes and stone burden. To reduce the certain complications, pediatric type of instruments is suitable but the use of adult instruments and techniques may achieve equal results.

A novel percutaneous nephrolithotomy (PCNL) set: The 'Economical One-shot PCNL Set' (Ecoset).

OBJECTIVES: To suggest a novel disposable percutaneous nephrolithotomy (PCNL) set that we named the 'Economical One-shot PCNL Set' (Ecoset), which consists of a single 30-F dilator, 30-F sheath, and 8-F polyurethane dilator, as use of a 'one-shot' dilatation technique during PCNL is becoming widespread. PATIENT AND METHODS: The medical records of 42 patients with kidney stones who had undergone 'one-shot' PCNL from February 2014 to June 2016 were retrospectively reviewed and analysed. Demographic data, as well as the stone size, radiation exposure time, operation time, hospitalisation duration, rate of treatment success and complications, were recorded. RESULTS: The mean (SD, range) age of the patients was 44.43 (16.54, 11-72) years. The mean (SD) stone size was 35.12 (17.53) mm. The mean (SD) operation time was 54.58 (22.24) min. The mean (SD) fluoroscopic screening time was limited to 154.72 (117.48) s. Treatment success was achieved in 32 (76%) patients. The mean (SD) hospital stay was 3.09 (0.75) days. None of the patients had any major complications. Bleeding requiring blood transfusion was required in three patients. The cost of a disposable dilatation set for a single PCNL operation with a balloon set, a standard Amplatz set, or an Ecoset is ∼$137, $120, or $27 (American dollars), respectively. CONCLUSIONS: The one-shot dilatation technique using the Ecoset for PCNL can be feasibly, safely, and effectively performed in almost every adult patient. The Amplatz dilator set and balloon dilator set have the disadvantage of relatively high cost, whereas the Ecoset is the cheapest 'disposable set' that can be used during PCNL surgery.

Effectiveness of ureteroscopy among the youngest patients: One centre's experience in an endemic region in Turkey.

BACKGROUND: In recent years, the incidence of urinary stone disease reportedly has been increasing. The use of shockwave lithotripsy has seen low success rates, the inefficacy of a single session, and the need for general anaesthesia in children; additionally, children are exposed to radiation. These suboptimal treatment conditions have all led to ureteroscopy (URS) becoming the treatment method of choice for paediatric ureter stones. The aim of this study is to examine the effectiveness of 4.5-Fr URS when used on children younger than 1 year of age. PATIENTS AND METHODS: The operation results of 34 patients (12 girls and 22 boys) who had undergone intervention for ureter stones at our clinic were retrospectively evaluated. For URS, a 4.5-Fr semi-rigid ureteroscope was used; a Holmium:YAG laser machine was used as a lithotripter. RESULT: The mean patient age was 9.6 months (range 4-12 months) (Table). The mean stone surface area was 25.39 mm2 (range 11.84-84.78 mm2). In six cases, a ureteral catheter was inserted, because of minimal oedema in the ureters; in nine cases, a Double J (DJ) stent was inserted. The mean operation time was 45.3 min (range 22-87 min). In the first week of control with urinary ultrasonography and kidney-ureter and bladder radiograph, a stone-free condition was determined in 28 (82.3%) patients. In two cases-in which sufficient fragmentation could not be achieved, because of minimal bleeding during operation-during the exertion of a DJ stent, another URS was performed. In the first postoperative month, a stone-free condition was established in 32 (94.1%) patients. The mean hospital stay period was 28.6 h (range 12-72 h). There were seven cases (20.5%) with Clavien II-III complications. CONCLUSION: Use of a ureteroscope is safe and effective with paediatric patients: we found that a 4.5-Fr ureteroscope can be safely used on children under 1 year of age. We therefore consider a 4.5-Fr ureteroscopic instrument to be an appropriate tool for treating URS in children within this age range.

Bilateral microperc in a severe kyphoscoliosis.

Percutaneous nephrolithotomy is the standard modality for large renal calculi in normal and abnormal renal anatomic situations. This case report describes a 57-year-old male patient who presented with bilateral kidney stones and severe kyphoscoliosis. He had successfully been treated with a bilateral microperc technique.

Comparison of Scoring Systems in Pediatric Mini-Percutaneous Nephrolithotomy.

OBJECTIVE: To apply urolithiasis scoring systems to the pediatric miniperc procedure and to compare their predictive capability for postoperative outcomes. MATERIALS AND METHODS: Records from 2 referral centers of patients under 18 years of age who had the miniperc procedure between 2010 and 2015 were retrospectively investigated. All patients included in the study were graded by the same surgeon according to Guy's and Clinical Research Office of the Endourological Society (CROES) scoring systems using preoperative imaging methods. Patient demographics and outcomes were compared according to the complexity of the procedure as graded by each scoring system. RESULTS: The mean age of the 97 patients was 7.1 ± 5.2 (1-17) years. The mean stone burden and number were 388.4 ± 233.9 mm(2) and 1.5 ± 1.3, respectively. The mean procedure, fluoroscopy, and hospitalization times were 78.2 ± 32.8 minutes, 144.8 ± 84.3 seconds, and 4.1 ± 2.8 days, respectively. The mean hematocrit drop was calculated as 2.2 ± 2.2. The mean scores were 1.7 ± 1.0 and 259.9 ± 50.6 for Guy's and CROES scoring systems, respectively. In the multivariate analysis, stone-free status was found to be associated with Guy's (r: -0.464, p: .000) and CROES (r: 0.490, : 0.000) scoring systems and stone burden (r: -0.161, p: .041). In the analysis of factors related to complication, Guy's score was identified as an independent predictor of complication (p: .02, odds ratio: 1.9, 95% confidence interval 1.097-3.319). CONCLUSION: According to our results, using Guy's and CROES scoring systems, stone-free ratios after percutaneous nephrolithotomy may be predicted preoperatively. In addition, Guy's system is a predictor of postoperative complication rate.

A novel drainage technique during micropercutaneous nephrolithotomy in pediatric patients: double angiocath.

Micropercutaneous nephrolithotomy (microperc) is a recently introduced percutaneous nephrolithotomy (PNL) technique that has the smallest tract size. The absence of an amplatz sheath during the microperc technique is a fundamental difference that distinguishes it from all other types of PNL (standard, mini, ultramini). Increasing of the intrarenal pelvic pressure (IPP) was demonstrated by the authors in adult patients but this problem may be even more serious in pediatric patients. Previously, the authors defined the use of a 14 gauge angiocath needle and sheath (microsheath) during microperc surgery for pediatric patient to reduce the IPP. In this novel technique, a second angiocath is used to access the renal collecting system to drain fluid during surgery. This technique is more effective in reducing IPP during microperc, especially in pediatric patients.

For reliable urine cultures in the detection of complicated urinary tract infection, do we use urine specimens obtained with urethral catheter or a nephrostomy tube?

OBJECTIVE: The aim of this study was to compare the results of urine cultures obtained either from urethral, and percutaneous nephrostomy (PCN) catheters. MATERIALS AND METHODS: This study included 328 consecutive patients that underwent PCN at our institution with complicated urinary tract infections (UTIs) between July 2010 and April 2015. Results of urine cultures obtained from the urethral and nephrostomy catheters were compared. RESULTS: This study included 152 male and 176 female patients. Mean age of the patients was 46.2±24.3 years. The main indications were obstructive uropathy due to urolithiasis complicated with pyonephrosis 145 (44%), malignant disease (n=87; 26%), pregnancy (n=26; 8%), and anatomical abnormality (n=23; 7%). One hundred and twenty three patients had diabetes mellitus. The most common causative organisms were Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Blood cultures showed the same results for the PCN and bladder urine cultures. The bladder urine culture was positive in 304 patients, while the PCN urine culture in 314 patients. CONCLUSION: PCN is an important treatment for the management of pyonephrosis. Cultures from the PCN yield valuable information that is not available from urethral urine cultures, and is a guiding tool for antibiotic therapy selection.

Laparoscopy assisted percutaneous stone surgery can be performed in multiple ways for pelvic ectopic kidneys.

Pelvic kidney stones remain a unique challenge to the endourologists. Treatment options include open surgery, extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy (PNL), retrograde intrarenal surgery, and laparoscopy assisted PNL (LA-PNL). As a minimal invasive option, LA-PNL can decrease the risk for bowel and major vessel injury. Here, we describe our experience using the LA-PNL procedures with different combinations, to treat kidney stones in multiple patients with a pelvic ectopic kidney (PEK). Eight patients, with PEK, kidney stones, and no other treatment choice, but open surgery, were included in the study. Two different laparoscopic techniques such as mesocolon dissection and transmesocolic, and four different percutaneous procedures such as standard-PNL, mini-PNL, micro-PNL, and a PNL through the renal pelvis were used for stone extraction in these patients. The mean age of patients was 25.6 ± 12.9 years and mean stone size was 524.1 ± 430.3 mm(2). Mean operation time was 150.5 ± 40.0 (77-210) min which was composed of retrograde catheterization (14.8 ± 2.9 min), laparoscopic procedure (48.7 ± 20.6 min) and PNL procedure (86.8 ± 31.1 min). Residual stones were seen in two patients (no additional treatment was need), while a 'stone-free' procedure was achieved in six patients (75.0 %). On the post-operative first month visit, a stone was observed on radiological examinations in only one patient (87.5 % stone-free). Mean hospitalization time was 2.8 ± 0.9 days. No perioperative or post-operative complication was observed in all patients. LA-PNL surgery is a safe and effective option for treatment of PEK stones, and has several alternative approaches.

Comparison of Retrograde Intrarenal Surgery and Micro-Percutaneous Nephrolithotomy in Moderately Sized Pediatric Kidney Stones.

PURPOSE: To compare the effectiveness and reliability of retrograde intrarenal surgery (RIRS) and micro-percutaneous nephrolithotomy (micro-perc) for the management of kidney stones in pediatric patients. MATERIALS AND METHODS: A retrospective analysis was made of pediatric patients aged <18 years with kidney stones that ranged from 10 to 20 mm in size, who underwent RIRS (n = 36) or micro-perc (n = 45) in referral centers. RESULTS: In the RIRS group, the mean age of patients was 8.39 ± 4.72 years and in the micro-perc group, it was 5.62 ± 4.50 years (p = 0.01). The mean stone size was 12.80 ± 3.03 mm in the RIRS group and 13.97 ± 3.46 mm in the micro-perc group (p = 0.189). The success rate was 86.2% (n = 31) in the RIRS group and 80.0% (n = 36) in the micro-perc group (p = 0.47). The mean complication rate was 16.6% and 13.3% in the RIRS and micro-perc groups, respectively (p = 0.675). Hospital stay and radiation exposure were significantly lower in the RIRS group (all p < 0.001). The mean anesthesia session was 1.94 in the RIRS group and 1.26 in the micro-perc group (p < 0.001). The mean hemoglobin drop was 0.53 ± 0.87 g/dL in the micro-perc group, and none of the cases required blood transfusion. CONCLUSION: The results of this study suggested that micro-perc and RIRS were highly effective methods for the treatment of moderately sized renal stones in children, with comparable success and complication rates. Patients and their parents should be informed about the currently available treatment options, and of their efficacy and safety. However, further clinical trials are needed to support these results.

Micro-percutaneous nephrolithotomy in the treatment of pediatric nephrolithiasis: A single-center experience.

OBJECTIVE: We aimed to clarify the applicability and safety of micro-PNL (microperc) in the treatment of pediatric kidney stones. MATERIAL AND METHODS: A single center prospective trial was initiated, and microperc was performed in 40 children using the same two methods: the classical all-seeing needle and microsheath method. Stone fragmentation was performed using a 200-µm holmium:YAG laser fiber. RESULTS: The mean age of the patients was 6.3±4.4years (range: 7months-16years). Fourteen were less than 3years old. The average calculous size was 16.5mm (range: 10-36mm). In 20 patients, access was achieved through the all-seeing needle method. In the other patients, access was achieved by the microsheath method. Conversion to mini-PNL was required in 2 patients due to intraoperative bleeding in one and a high stone burden in the other. The mean hospital stay was 3.8±1.2days (range: 1-10days), and the mean hemoglobin decrease was 0.7±0.3mg/dl (range: 0-1.7mg/dl).The duration of surgery and fluoroscopic screening was 75min and 3.7min, respectively. A DJ stent was placed in 11 patients due to a high stone burden. A ureteral stent was left for 1day in the rest of the cases. Complete clearance was achieved in the other 32 children. None of the patients required transfusion caused by renal hemorrhage. In 1 patient, extravasation of the irrigation fluid caused abdominal distention. As assessed by KUB and/or an ultrasound, the overall stone-free rate at 6weeks was 80%. There were residual fragments in 6 patients (15%). CONCLUSIONS: Our results show that microperc is a safe and effective procedure for the treatment of pediatric kidney stones. Children with small renal calculi and with nonobstructed collecting systems are suitable for microperc.

STPEDISET: A novel innovation for percutaneous nephrolithotomy in children.

PURPOSE: The aim of this study was to report the outcomes of PCNL in patients in whom the Short and Thin Pediatric Set (ST PEDISET) had been used. METHODS: Data from 21 patients (11 boys and 10 girls) who underwent PCNL for renal stones using the ST PEDISET between April 2013 and February 2015 were analyzed retrospectively. The patients were evaluated by plane radiography and USG after surgery. RESULTS: In total 21 children (11 boys and 10 girls) with a median age of 13months (range 5months to 4years) who underwent PCNL were included in the study. The median stone burden was 16mm (range 10-36mm). The success rate was 85.7%. Sixteen patients (76.2%) were stone free and two patients (9.5%) had clinically insignificant residual fragments (CIRF). The median length of hospital stay was 4days (range 2-9days). CONCLUSIONS: The data of this study clearly show that the ST PEDISET is safe, effective and ergonomic for percutaneous nephrolithotomy in preschool-age children. This study indicates the need for randomized trials on larger cohorts to confirm these findings, and thus improve the surgical procedure.

Micro-percutaneous nephrolithotomy in infants: a single-center experience.

This study aimed to investigate the effectiveness and reliability of micro-percutaneous nephrolithotomy (micro-PNL) for the management of kidney stones in pediatric patients. This retrospective study included 24 infants that underwent micro-PNL for renal stones between March 2012 and April 2015. The inclusion criteria included: age younger than 2 years, stone size <20 mm, absence of urinary tract malformations and active infection, and no coagulopathy. Stone-free rates were assessed one month postoperatively by ultrasonography (USG) and kidneys, ureters, bladder (KUB) radiography. Complications were classified according to the Clavien classification system. The mean age of the patients was 15.8 ± 7.8 months (range, 8-23) and the mean stone size was 13.5 ± 3.84 mm. Intra-renal access was achieved using USG in 11 patients and KUB fluoroscopy in 13 patients. The operation time and fluoroscopic screening time were 53.7 ± 10.35 and 1.4 ± 0.9 min, respectively. The mean hospital stay was 2.5 ± 0.8 days, and the mean drop in the hemoglobin level was 0.51 ± 0.34 g/dL. Bleeding requiring blood transfusion was not observed. A ureteral J stent was implanted perioperatively in four patients because of stone burden. Four patients complained of postoperative renal colic (Clavien grade 1) and postoperative fever was observed in two patients. Definitive success rates were as follows: the stone-free rate was 83.3% (n = 20) and residual fragments were observed in four patients.