Öz

 Objective: Several methods including extracorporeal shock wave lithotripsy(ESWL), standard percutaneous nephrolithotomy(PCNL), mini-PCNL and retrograde intrarenal surgery(RIRS) have been recommended to treat kidney stones. A major advantage of mini-PCNL is that it provides similar stone-free and success rates and is less invasive when compared with standard PCNL. In this report, we evaluated our experiences and outcomes with mini-PCNL in a pediatric population. 

Material and Methods: From January 2011 to November 2016, the medical records and radiographic images of children who underwent mini-PCNL with a 15 Fr peel-away sheath and 12 Fr miniature nephroscope were evaluated. We reviewed the patients’ demographic details, hemogram, stone characteristics, stone free rate and success rates, additional procedures, complications, hospital stay and nephrostomy retrieval. Stones were classified according to kidney localization as simple (single calyx or pelvic stones) or complex (choraliform, pelvic+calyx stones or multiple calyx stones). 

Results: The study included 12 girls and 28 boys, with a mean age of 7.84±5.62 years (1-17 years). The mean diameter of the stones was 24.4±15.3 mm (10-65 mm). The mean stone size was 14.76±6.52 mm for the simple stone group and 35.05±15.22 mm for the complex stone group (p=0.000). The mean operative and fluoroscopy times were 89.17±31.48 minutes and 146.35±63.16 seconds. The first success rate was 55% (n=22). 8 patients underwent additional procedures and the success rate increased to 77.5% (n=31). The success rate was significantly higher in simple stones (95.2% vs. 57.9%; p=0.005). The complication rate of the mini-PCNL procedure was 22.5% (n=9). The mean hemoglobin decrease was 0.73±1.06 mg/dl and only 1 patient required a blood transfusion. The mean hospital stay and nephrostomy retrieval time was 3.77±2.32 and 2.00±1.70 days, respectively. 

Conclusion: Our experiences indicate that mini-PCNL is a safe and effective procedure for the management of renal stones in children and stone-free and success rates similar to standard PCNL are obtained. 

Anahtar Kelimeler

• Kidney stone,Mini,Pediatric

Çocukluk Çağı Böbrek Taşı Hastalığında Mini Perkütan Nefrolitotomi Tek Merkez Deneyimlerimizin Değerlendirilmesi

Öz

 Amaç: Böbrek taşlarının tedavisinde ekstrakorporeal şok dalga litotripsi (ESWL), standart perkütan nefrolitotomi (PCNL), mini PCNL ve retrograd intrarenal cerrahi (RIRS) gibi çeşitli yöntemler önerilmiştir. Mini PCNL’nin en büyük avantajı, standart PCNL’ye kıyasla benzer taşsızlık ve başarı oranları sağlaması ve daha az invazif olmasıdır. Bu makalede çocuklardaki mini PCNL deneyimlerimizi ve sonuçlarımızı değerlendirdik. 

Gereç ve Yöntemler: Ocak 2011’den Kasım 2016’ya kadar kliniğimizde 12 Fr minyatür nefroskop ve 15 Fr’lik mini PCNL kılıfı kullanarak mini PCNL uygulanan çocukların tıbbi kayıtları ve radyografik görüntüleri değerlendirildi. Hastaların demografik bilgileri, hemogramı, taş özellikleri, taşsızlık ve başarı oranları, ek müdahaleler, komplikasyonlar, hastanede kalış ve nefrostomi çekim zamanı gözden geçirildi. Taşlar, böbrek lokalizasyonuna göre basit (tek kaliks veya pelvik taşlar) veya kompleks taşlar (koraliform, pelvik + kaliks taşları veya çoklu kaliks taşları) olarak sınıflandırıldı. 

Bulgular: Araştırmaya 12 kız ve 28 erkek alındı, yaş ortalaması 7.84±5.62 yıl (1-17 yıl)’dı. Taşların ortalama çapı 24.4±15.3 mm (10-65 mm)’di. Basit taşların boyutu ortalama 14.76 ± 6.52 mm iken, kompleks taşların ortalama boyutu 35.05±15.22 mm’di (p=0,000). Operasyon süresi ortalama 89.17±31.48 dakika, skopi süresi 146.35±63.16 saniyeydi. İlk başarı oranı %55 (n=22)’di. 8 hastaya ek müdahalelerde bulunuldu ve ameliyattan 12 hafta sonra başarı oranı %77.5’e (n=31) yükseldi. Basit taşlar, kompleks taşlarla karşılaştırıldığında başarı oranı belirgin olarak yüksekti (%95.2 vs %57.9; p = 0,005). Mini PCNL ameliyatının komplikasyon oranı %22.5 (n=9)’di. Ortalama hemoglobin düşüşü 0.73±1.06 mg/ dl’di ve sadece 1 hastada kan transfüzyonu gerekli oldu. Ortalama hastanede kalış süresi ve nefrostomi çekim süresi sırasıyla 3.77±2.32 ve 2.00±1.70 gündü. 

Sonuç: Deneyimlerimiz mini PCNL’nin çocuklarda böbrek taşlarının tedavisi için güvenli ve etkin bir yöntem olduğunu ve standart PCNL’ye benzer taşsızlık ve başarı oranları elde edildiğini desteklemektedir. 

Anahtar Kelimeler

• Böbrek taşı,Mini,Pediatrik

Kaynakça

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