Pediatric Urology Clinic, Konya City Hospital, Konya, Turkey.
Department of Urology, Medistate Hospital, Istanbul, Turkey.
J Endourol. 2024 Feb;38(2):121-128. doi: 10.1089/end.2023.0278.
Percutaneous nephrolithotomy (PNL) is the treatment of choice in children with complex and large stones. With the experience gained from adult practice, supine PNL is increasingly performed in children as well. We aimed to evaluate the comparative results of prone and supine mini-PNL (m-PNL) performed for large/complex stones in children. The study included children who underwent supine and prone m-PNL at two centers between September 2019 and 2022. Patients were divided into two groups with a 1:1 ratio to index supine m-PNL and prone m-PNL cases for the size, number, location of the stones, degree of hydronephrosis, and age. Operative related parameters, success, and complication rates are being discussed on a procedure-based manner. Forty-two patients (21 supine and 21 prone) were included. The mean age was 9.6 ± 4 years and mean stone size was 28.8 ± 13.6 mm. Regarding the operative data, the mean duration of procedure time was 65.7 ± 17.8 minutes in supine group, whereas 86.9 ± 19.0 minutes in prone group ( = 0.001). Fluoroscopy time was shorter in supine group ( = 0.027). Tubeless PNL was performed in 11 cases of prone group (52%), whereas this number was 18 (86.7%) in supine group ( = 0.019). Stone-free rates were similar in both groups (supine m-PNL: 90.5%, prone m-PNL: 85.7%, = 0.634). Complications were minor in nature in most of the cases of both groups, which resolved with supportive measures in a short period of time. However, there was a statistically significant difference regarding the location and number accesses between two groups ( = 0.008). Simultaneous flexible ureterorenoscopy was performed in eight patients in the supine PNL group (<0.001). Our current findings and the highly limited data reported in the literature indicate that as an established minimal invasive treatment alternative m-PNL procedure in supine position can also be performed with similar success and complication rates in pediatric population.
经皮肾镜碎石术 (PNL) 是治疗儿童复杂性和大结石的首选方法。随着成人实践经验的积累，俯卧位 PNL 也越来越多地用于儿童。我们旨在评估儿童大/复杂结石行仰卧位和俯卧位微创经皮肾镜碎石术 (m-PNL) 的对比结果。 本研究纳入了 2019 年 9 月至 2022 年期间在两个中心接受仰卧位和俯卧位 m-PNL 的儿童患者。患者按照 1:1 的比例分为两组，以指数仰卧位 m-PNL 和俯卧位 m-PNL 病例的大小、数量、结石位置、肾积水程度和年龄进行分组。手术相关参数、成功率和并发症发生率均以手术为基础进行讨论。 42 名患者（21 名仰卧位和 21 名俯卧位）入组。平均年龄为 9.6±4 岁，平均结石大小为 28.8±13.6mm。关于手术数据，仰卧位组的手术时间平均为 65.7±17.8 分钟，而俯卧位组为 86.9±19.0 分钟（ = 0.001）。透视时间在仰卧位组较短（ = 0.027）。在俯卧位组中有 11 例（52%）进行了无管经皮肾镜碎石术，而在仰卧位组中有 18 例（86.7%）（ = 0.019）。两组的结石清除率相似（仰卧位 m-PNL：90.5%，俯卧位 m-PNL：85.7%， = 0.634）。两组大多数患者的并发症均为轻度，经短期支持治疗后均可缓解。然而，两组之间的位置和数量通道存在统计学显著差异（ = 0.008）。在仰卧位 PNL 组中有 8 例患者同时进行了软性输尿管镜碎石术（ <0.001）。 我们目前的发现和文献中报告的非常有限的数据表明，作为一种已确立的微创治疗替代方法，仰卧位 m-PNL 也可以在儿科人群中以相似的成功率和并发症发生率进行。
