V05-02 the Apotheosis of Minimally Invasive Complex Pediatric Kidney Stone Treatment: Fluoroscopy-Free, Supine (With Laryngeal Mask AIrway), Totally Tubeless, Ambulatory, Mini Percutaneous Nephrolithotomy

You have accessJournal of UrologyPediatrics (V05)1 May 2024V05-02 THE APOTHEOSIS OF MINIMALLY INVASIVE COMPLEX PEDIATRIC KIDNEY STONE TREATMENT: FLUOROSCOPY-FREE, SUPINE (WITH LARYNGEAL MASK AIRWAY), TOTALLY TUBELESS, AMBULATORY, MINI PERCUTANEOUS NEPHROLITHOTOMY Nir Tomer, Alexandra Siegal, Neha Malhotra, and Johnathan Khusid Nir TomerNir Tomer , Alexandra SiegalAlexandra Siegal , Neha MalhotraNeha Malhotra , and Johnathan KhusidJohnathan Khusid View All Author Informationhttps://doi.org/10.1097/01.JU.0001009516.84627.21.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pediatric kidney stone disease presents unique surgical challenges. These patients are sensitive to radiation, stent colic, and nephrostomy tube discomfort and stent removal requires exposure to general anesthesia. The pediatric collecting system is small and challenging to navigate, often making percutaneous nephrolithotomy (PCNL) the treatment of choice. However, prone positioning and intubation have risks and overnight hospital stays can be frightening for these patients. We present a case that addresses these challenges. To our knowledge this is the first pediatric Fluoroscopy-Free, Supine (With Laryngeal Mask Airway (LMA)), Totally Tubeless, Ambulatory, Mini PCNL. METHODS: We present the case of a 15 year-old female recurrent stone former with cystinuria, found to have a 6 mm left proximal ureteral stone and two left lower pole stones (5 mm, 4 mm), requiring urgent left stent placement. For definitive stone management, the patient underwent an ambulatory mini PCNL, performed in the modified supine position, with an LMA, fluoroscopy free, and totally tubeless. The patient was positioned into a modified supine position with a 30-degree lateral tilt. The stent was removed and a P6 flexible ureteroscope (Olympus) was used to perform a diagnostic ureteroscopy to confirm stone placement and identify our lower-pole access site. Intraoperative renal ultrasound was used to identify the tip of the scope. Percutaneous access was performed under combined sonographic and direct endoscopic visual guidance. Left PNCL using a Trilogy lithotripsy (Boston Scientific) was then performed. RESULTS: At completion, a pyeloscopy and ureteroscopy confirmed no remaining stone fragments. A 5Fr ureteral catheter was then placed retrograde into the pelvis and connected to the patient's 16Fr foley catheter. After one hour in the recovery room, the foley catheter and ureteral catheter were removed. The patient was discharged shortly thereafter without issue. On POD 6, we called the patient who was doing well, without pain or discomfort. CONCLUSIONS: In the pediatric population, all modalities in the endourologist's armamentarium should be utilized to maximize likelihood of stone free rates while mitigating the risks of surgery. We show that techniques such as modified supine position, fluoroscopy free access, LMA for airway, ambulatory discharge, and leaving the patient totally tubeless at discharge are feasible and can be used together in a well selected pediatric patient. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e268 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Nir Tomer More articles by this author Alexandra Siegal More articles by this author Neha Malhotra More articles by this author Johnathan Khusid More articles by this author Expand All Advertisement PDF downloadLoading ...