Ultrasound-guided mini-percutaneous nephrolithotomy in patients aged less than 3 years: the largest reported single-center experience in China

To investigate the efficacy and safety of mini-percutaneous nephrolithotomy (mini-PCNL) under total ultrasonography in patients aged <3 years. Methods: We reviewed 56 patients (67 renal units) aged <3 years between August 2006 and December 2012 in our units, including 31 renal units with a single stone, 6 with staghorn stones, 10 with upper ureteral stones, and 20 with multiple stones. The mean age of the patients was 24 (range 6–36) months and the mean maximum stone diameter was 18.9 (range 10–32) mm. The puncture site selection and tract dilation were guided by Doppler ultrasonography solely. All procedures were performed using 12–16 Fr tracts. Stones were fragmented using pneumatic lithotripsy and a holmium laser with an 8/9.8 Fr rigid ureteroscope. Forty-five patients with unilateral stones underwent a single procedure, and 11 patients with bilateral stones underwent two procedures. The mean time to establish access was 2.9 (range 2.1–5) min, the mean operative time was 36.8 (range 20–88) min, the mean decrease in hemoglobin concentration was 8.7 (2–15) g/L, and the stone-free rate at hospital discharge was 92.5 %. The mean postoperative hospital stay was 7.1 (range 3–13) days. Post-procedure complications included fever (>38.5 °C) in four patients, and reactive pleural effusion in one patient. Blood loss requiring transfusion, sepsis, adjacent organ injury, and kidney loss were not observed. Ultrasound-guided mini-PCNL is feasible and safe in patients aged <3 years, without major complications or radiation exposure.