الفهرس 
Aim Of The WorkOnly 14 pages are availabe for public view
 |  | from | 122 |  |  |
| | | from | 122 | | |
Abstract
This study was designed to evaluate the safety, efficacy, and morbidity as well as the usefulness of modified tubeless minimally invasive percutaneous nephrolithotomy (mini-Perc) for management of renal stones in children.
To achieve this purpose 50 child suffering from renal stones were included in this study between September 2017 and September 2018 which was held at Urology Department at Benha University Hospital ; all children between 4 years and 16 years with single renal stone less than 2 cm were included in this study while patients with uncorrectable coagulopathy, congenital anomalies in the kidney such as ectopic pelvic kidney or horseshoe kidney, unfavorable anatomy, multiple or staghorn stones and untreated urinary tract infections were excluded from the study.
The mean age was 8.64±3.19 (4.0-16.0).BMI in Kg/sq.m (mean ± SD) was 20.98±2.82 (17.0-29.0) , in between 17<24 BMI (mean ± SD)
was 45(90.0), while ≥24 BMI (mean ± SD) was 5(10.0).The study included 32 males (64%) and 18 females (36%), 2 patients(4%) had previous ESWL on the left kidney, 3 patients (6%) had previous renal stone surgery on the left , 1 patient (2%) had previous ESWL on the right kidney and 1 patient (2%) had previous renal stone surgery on the right .
Stone characteristics of the studied cases. As for stone side 20 cases (40%) cases were on the right Side and 30 cases (60%) on the left. For stones radio- opacity there were 40 (80%) radio-opaque stones and 10 (20%) radio-lucent stones . For stones site there were 19 (38%) pelvic stones, 29 cases (58%) had calyceal stones (5 upper, 5 middle and 19
lower calyx) and 2 cases (4%) had combined pelvic and lower calyceal stones . As for stone size mean ±SD (range) was 1.52±0.29 (1.0-2.0) .
The intra-operative data of the studied cases; fluoroscopic time
/minutes mean ±SD (range) was 7.68±2.21 (3.0-10.0) , Operative time/minutes mean ±SD (range) was 89.10±29.39 (40-120) , 28 (56%) cases were done in the supine position and 22 cases (44%) were done in the prone position according to surgeon preference, Access time /minutes mean ±SD (range) was 1.32±0.83 (0.25-3.0) , Access trials mean ±SD (range) 2.58±1.37 (1-5). Intra-operative morbidity were 2 cases (4%), 1 case (2%) had significant bleeding for which one unit blood was transfused, 1 case (2%) had pelvic perforation and extravasation it was small perforation, these two cases were stone free and postoperative nephrostomy tube was inserted in both cases. Of all 50 patients , 48 cases (96%) were done by the modified tubeless technique in which a ureteric or single j were externalized through the track while in 2 cases (4%) nephrostomy tube was inserted ( one case had a significant bleeding and the other had renal pelvis perforation ).
postoperative data; 2 cases (4%) had postoperative fever , Hb post- operative mean ±SD (range) was 11.88±1.08 (9.5-14.0) , Mean Hb DROP was 0.91±0.47 (0.50-2.0) with a P value of <0.001. Of all the 50 patients , 40 cases (80%) were stone free while 10 cases (20%) had residual stones that needed second look for extraction after recovering the track through the externalized single J ureteric catheter. The hospital stay/day mean
±SD (range) was 1.42±0.53 (1-3) and the pain score mean ±SD (range) was 2.08±1.05 (1-5), pain score was (5) in the 2 cases in which nephrostomy tube was inserted and postoperative analgesia/mg mean
±SD (range) was 89.8±8.52 in which we used diclophenac sodium injection.
we found that modified tubeless mini PCNL in children is safe and efficacious as it is associated with high stone free rate , less hemoglobin DROP and rate of blood transfusion, less incidence of intraoperative and postoperative complications. Also the modified tubeless technique gives us the perfect combination of less postoperative pain and analgesic requirement, short hospital stay and in the same time is considered an alternative approach to tubeless surgery that allows a second percutaneous procedure using the same tract.
The most important drawback of mini PCNL is lengthy operative time , due to, the need for fragmentation into very small stones suitable for ureteroscopic graspers and/or baskets, and the small sheath. Which may lead to diminished intraoperative field visibility.
One of the study limitations is the unavailability of Laser lithotriptor in our department. We believe the technique may be easier by the use of stone dusting technique by Laser lithotriptor.
We recommend also use of suction attachment to the pneumatic lithotriptor to decrease the operative time through extraction of small fragments.