MPCNL Treatment Of Upper Urinary Tract Calculi In Children

Objective: To study the safety and efficacy of MPCNL operation in the treatment of upper urinary tract calculi in children.Methods: The clinical data of 5 children with upper urinary tract calculi treated by MPCNL in the Department of Urology of the affiliated Hospital of Jining Medical College from January 2019 to September 2022 were analyzed retrospectively.Including the preoperative condition of the patients,intraoperative and postoperative follow-up.Operation procedure:direct prone position after anaesthesia urinary catheterization,ultrasound-guided localization,puncture site at renal calyceal fornix,puncture with 18 G puncture needle,puncture needle into target renal calyx under ultrasound guidance,clear fluid flow from hydronephrosis kidney after pulling out needle core,guided by 0.038-inch zebra guide wire,incision of skin about 0.8cm incision at puncture point,introduction of 16 F fascial dilator with sheath tube by one-shot expansion method.Enter the target renal calyx,establish a percutaneous renal channel,enter the ureteroscope,see the stone,withdraw the zebra guide wire,and then remove the stone by holmium laser lithotripsy.After repeated exploration under the microscope,no residual stones were detected,and no residual stones were confirmed by color ultrasound,and the operation was ended.Results: In this study,5 patients were collected,including 3 males and 2 females,with a median age of 4 years(3-12).The BMI was12.8～26.4kg/m2 and the median BMI was 16.7kg/m2(13.9-22.2).5 cases were treated with MPCNL(3 cases of preschool age,2 cases of school age,partial untubulization,placement of ureteral stent and no nephrostomy tube).The operation time was 170.63 minutes,the success rate of one puncture was 80%,the median time of operation was 20.0minutes(18.5-48),the median value of intraoperative blood loss was2.0ml(1.5-10),the median of total hospital stay was 5 days(4.5-7.5),and the median postoperative hospital stay was 3 days(2.0-3.5).There were no complications such as severe bleeding,infection,high fever,injury of adjacent organs,dilution hyponatremia and so on.The postoperative follow-up patients recovered well,and no residual stones were found by color Doppler ultrasound or urinary CT 1 day after operation.The stone clearance rate was 100%.No stone recurrence was found during the follow-up one month after operation.Conclusion: Upper urinary tract calculi in children can be treated with MPCNL without artificial hydronephrosis,and the operation is safe and effective.It is safe and effective for children to be treated with MPCNL.