Background：Urolithiasis in pediatric population is a serious problem with the incidence increased these years.In the management of larger stones （diameters 〉2 cm）,percutaneous nephrolithotomy （PCNL） is considere...Background：Urolithiasis in pediatric population is a serious problem with the incidence increased these years.In the management of larger stones （diameters 〉2 cm）,percutaneous nephrolithotomy （PCNL） is considered to be the gold standard.This study aimed to investigate the efficacy and safety of mini-PCNL under total ultrasonography in patients aged 〈3 years.Methods：We reviewed 68 patients （80 renal units） aged 〈3 years between August 2006 and December 2014 in Peking University People＆#39;s Hospital and Beijing Tsinghua Changung Hospital,including 36 renal units with a single stone,6 with staghom stones,14 with upper ureteral stones,and 24 with multiple stones.The mean age of the patients was 24.2 months （range 6-36 months）,and the mean maximum stone diameter was 19.2 mm （range 10-35 mm）.The puncture site selection and tract dilation were guided by Doppler ultrasonography solely.All procedures were performed using 12-16 Fr tracts.Stones were fragrnented using pneumatic lithotripsy and a holmium laser with an 8/9.8 Fr rigid ureteroscope.Results：Fifty-six patients with unilateral stones underwent a single session procedure,and 12 patients with bilateral stones underwent two procedures.The mean time to establish access was 2.8 min （range 1.8-5.0 min）,the mean operative time was 36.5 min （range 20-88 min）,the mean decrease in hemoglobin concentration was 8.9 g/L （2-15 g/L）,and the stone-free rate （SFR） at hospital discharge was 94.0%.The mean postoperative hospital stay was 7.1 days （range 3-13 days）.Postprocedure complications included fever （〉38.5℃） in five patients and reactive pleural effusion in one patient.Blood loss requiring transfusion,sepsis,adjacent organ injury,and kidney loss were not observed.Conclusions：This study indicated that ultrasound-guided mini-PCNL is feasible and safe in patients aged 〈3 years,without major complications or radiation exposure.展开更多
To the Editor： Percutaneous nephrolithotomy （PCNL） is first-line therapy for ＂staghorn＂ stones. A multi-access approach is the mainstay of treatment in many cases because the stone burden is high. Finding feasibl...To the Editor： Percutaneous nephrolithotomy （PCNL） is first-line therapy for ＂staghorn＂ stones. A multi-access approach is the mainstay of treatment in many cases because the stone burden is high. Finding feasible parameters to predict the outcome of treatment for staghorn stones is important. The factors that can affect PCNL are controversial. Several parameters, such as the infundibular-pelvic angle （IPA）, upper-lower calyx angle （ULCA）, infundibular length （IL）, and infundibular width （IW） were important to affect the result of the operation. Whether the objective parameters in computed tomography （CT） can predict success through a particular approach has not been evaluated. This study investigated if the anatomy of the collecting system could improve the outcome in selected patients according to pretreatment images.展开更多
文摘Background：Urolithiasis in pediatric population is a serious problem with the incidence increased these years.In the management of larger stones （diameters 〉2 cm）,percutaneous nephrolithotomy （PCNL） is considered to be the gold standard.This study aimed to investigate the efficacy and safety of mini-PCNL under total ultrasonography in patients aged 〈3 years.Methods：We reviewed 68 patients （80 renal units） aged 〈3 years between August 2006 and December 2014 in Peking University People＆#39;s Hospital and Beijing Tsinghua Changung Hospital,including 36 renal units with a single stone,6 with staghom stones,14 with upper ureteral stones,and 24 with multiple stones.The mean age of the patients was 24.2 months （range 6-36 months）,and the mean maximum stone diameter was 19.2 mm （range 10-35 mm）.The puncture site selection and tract dilation were guided by Doppler ultrasonography solely.All procedures were performed using 12-16 Fr tracts.Stones were fragrnented using pneumatic lithotripsy and a holmium laser with an 8/9.8 Fr rigid ureteroscope.Results：Fifty-six patients with unilateral stones underwent a single session procedure,and 12 patients with bilateral stones underwent two procedures.The mean time to establish access was 2.8 min （range 1.8-5.0 min）,the mean operative time was 36.5 min （range 20-88 min）,the mean decrease in hemoglobin concentration was 8.9 g/L （2-15 g/L）,and the stone-free rate （SFR） at hospital discharge was 94.0%.The mean postoperative hospital stay was 7.1 days （range 3-13 days）.Postprocedure complications included fever （〉38.5℃） in five patients and reactive pleural effusion in one patient.Blood loss requiring transfusion,sepsis,adjacent organ injury,and kidney loss were not observed.Conclusions：This study indicated that ultrasound-guided mini-PCNL is feasible and safe in patients aged 〈3 years,without major complications or radiation exposure.
文摘To the Editor： Percutaneous nephrolithotomy （PCNL） is first-line therapy for ＂staghorn＂ stones. A multi-access approach is the mainstay of treatment in many cases because the stone burden is high. Finding feasible parameters to predict the outcome of treatment for staghorn stones is important. The factors that can affect PCNL are controversial. Several parameters, such as the infundibular-pelvic angle （IPA）, upper-lower calyx angle （ULCA）, infundibular length （IL）, and infundibular width （IW） were important to affect the result of the operation. Whether the objective parameters in computed tomography （CT） can predict success through a particular approach has not been evaluated. This study investigated if the anatomy of the collecting system could improve the outcome in selected patients according to pretreatment images.
