PERCUTANEOUS NEPHROLITHOTOMY IN INFANTS AND PRESCHOOL AGE CHILDREN - EXPERIENCE WITH A NEW TECHNIQUE

Objectives. To develop a less invasive method for performing percutane ous nephrolithotomy (PCNL) with the intent of decreasing the morbidity of the procedure in young children. Methods. A novel percutaneous ren al access technique (''mini-perc'') was developed using an 11F peel-aw ay vascular access sheath. Tract dilation and insertion of the sheath into the collecting system was performed with a single pass over an ac cess wire. PCNL was performed using pediatric instruments and electroh ydraulic lithotripsy. Sheath design improvements were implemented that make it specific for pediatric PCNL. Results. Eleven procedures have been performed with the 11F sheath. Patient age ranged from 2 to 6 yea rs (mean 3.4) and weight from 5 to 24 kg (mean 12.5). The average ston e burden was 1.2 cm(2). Mean procedure time, estimated blood loss, and length of hospitalization were 203 minutes, 25 mt, and 6 days, respec tively. Six (85%) of 7 patients are currently stone free with an avera ge follow-up of 12 weeks. No patient required transfusion, developed u rosepsis, or had a procedure-related complication. One procedure was p erformed in an outpatient setting with no postoperative nephrostomy tu be. Conclusions. The 11F ''mini-perc'' technique was successful in ren dering 85% of patients stone free with minimal morbidity. Its advantag es over obtaining access with standard 24 to 34F access sheaths includ e a smaller skin incision, single-step dilation and sheath placement, good working access for pediatric instruments, variable length, and lo wer cost. In addition, the hypothesized decrease in renal and body wal l trauma may result in less pain, reduced severity or risk of complica tions, and shorter hospital stays including the possibility of perform ing ''tubeless'' outpatient PCNLs. Further study is needed to confirm these possibilities. UROLOGY 52: 697-701, 1998. (C) 1998, Elsevier Sci ence Inc. All rights reserved.