V05-04 Supine Tubeless Mini-PCNL in a Pediatric Patient

You have accessJournal of UrologyPediatrics (V05)1 May 2024V05-04 SUPINE TUBELESS MINI-PCNL IN A PEDIATRIC PATIENT Jordan M. Smith, Rani Ashouri, Marc Abboud, Cynthia Sharidan, Romano DeMarco, Christopher E. Bayne, and John M. DiBianco Jordan M. SmithJordan M. Smith , Rani AshouriRani Ashouri , Marc AbboudMarc Abboud , Cynthia SharidanCynthia Sharidan , Romano DeMarcoRomano DeMarco , Christopher E. BayneChristopher E. Bayne , and John M. DiBiancoJohn M. DiBianco View All Author Informationhttps://doi.org/10.1097/01.JU.0001009516.84627.21.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We describe a novel technique for treatment of pediatric nephrolithiasis. METHODS: We present a case of a 12 year old female with cystinuria who was found on surveillance imaging to have a left lower pole stone burden of 1.7 centimeters. After discussion of management options with the patient and parents, they elected to proceed with miniaturized PCNL. She was pre-stented. For our equipment, we typically utilize the Storz MIPS set with the 16 french outer sheath. For lithotripsy, we typically utilize the High Powered Holmium Laser with pulse modulation due to increased efficiency. Patients are typically positioned in the modified supine split leg, or Valdivia, position. Access is accomplished as previously described by Giusti et al with retrograde pyelogram performed to delineate the anatomy and the relationship of the calyces' to the stone for puncture site and trajectory. Once access is obtained, we proceed with antegrade and retrograde pyeloscopy and lithotripsy for complete stone removal. RESULTS: Operating room time was 2 hours and 26 minutes with a total fluoroscopic radiation usage of 0.56 gray. Estimated blood loss was minimal. She was observed overnight with an indwelling foley, which was removed the following day. She was discharged on post operative day 1 to follow up in 2 weeks with stent removal. Postoperative imaging is typically accomplished with ultrasound given our concern for radiation. There was no evidence of obstruction or significant stone burden. CONCLUSIONS: Mini PCNL techniques have been shown to have lower postoperative pain, higher tubeless rates, and lower complications with similar stone free rate in adults. These advantages are also attractive in the pediatric population, especially in children with genetic pre-dispositions for stone formation who might require multiple lithotripsy procedures throughout their lifetime. In this technique video, we demonstrate a safe, effective approach to large stone volume lithotripsy in a pediatric patient with cystinuria. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e269 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Jordan M. Smith More articles by this author Rani Ashouri More articles by this author Marc Abboud More articles by this author Cynthia Sharidan More articles by this author Romano DeMarco More articles by this author Christopher E. Bayne More articles by this author John M. DiBianco More articles by this author Expand All Advertisement PDF downloadLoading ...