Dr. A.K. Singal MBBS (Gold Medalist), DNB, MNAMS
M.CH (AIIMS, Gold Medalist)
Stecker Scholar Pediatric Urology (USA)

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A 20-month-old boy with kidney stones managed with Mini-perc laser kidney stone surgery

Master S.C. had recurrent urinary infections requiring antibiotic injections since 1 year of age. He had required multiple admissions at hospitals for antibiotic courses.

At 20months of age, he was referred to us with an ultrasound scan showing large stones in both kidneys. A CT scan was done to see the size and shape of the stones properly. CT scan showed the kidney stones to be of “Staghorn” type. Staghorn literally meaning like horns of a stag- are the stones with a very complicated anatomy and they extend into sub-branches of urine collecting system within the kidneys and are as such very difficult to remove completely. In the present case as both the kidneys were involved with large stones, the management decisions were even more difficult.

The options were:

  1. Both sides open surgery: S.C. was advised kidney stone open surgery for removal of stones and open surgery was offered at some hospitals. Open Surgery for kidney stones especially of Staghorn variety is a major procedure where the whole kidney has to be split open and there are high chances of major blood loss, kidney damage and other complications. We generally do not advise open surgery for children with kidney stones.
  2. Mini-Perc (also called Mini- PCNL)- Percutaneous Nephrolithotomy (PCNL or Perc) is a procedure routinely employed for such kidney stones in adults. It entails making a direct puncture into the kidney through the back with a fine needle under x-ray radiological guidance. Through the needle a guidewire is then placed and the route to the kidney stone is made gradually bigger to about 1cm by stepwise dilatation. Finally, a telescope called nephroscope is placed and the stone is broken down into small pieces with soundwaves or Laser and removed. Adult instruments are bigger and allow removal of large pieces. Same sized instruments if used in young children can lead to kidney damage and bleeding.
  3. For kidney stone treatment in a child, we use a technique called – Mini-perc or Mini PCNL, which is the best technique for kidney stone used by expert Pediatric urologists. The size of the telescope is 12 French (adult is 20/24 Fr) and this can be easily used in small kids. The small cut on the back is less than 5mm and is safe for a developing small kidney. After that we break the stone into small pieces using holmium laser for kidney stones. Larger fragments cannot be removed but Holmium Laser comes in handy in breaking these stones into small pieces which are then removed or washed out.
  4. Master S.C. was taken up for Mini-perc and Holmium LASER on right side first (the side with the larger stone) at MITR healthcare Hospital, Kharghar . The surgery was completed without any blood loss and complete clearance of the stone was achieved. Shashank was discharged 3 days later withour any stitches and a small bandaid dressing on the back.
  5. He remained free of any urine infections with minor oral antibiotics and was readmitted 3 weeks later for left side Mini-perc+ Holmium Laser. Left side kidney stones were also cleared completely and he was discharged 2 days later. More than 3 months after second surgery, he is at home free of stones, infections and scars.
  6. Master S.C. is one of the youngest kids in India to undergo successful Mini-perc for both sided kidney stones.

ultrasound for kidney stone
Ultrasound scan of right kidney showing large kidney stone
Test for kidney stone
Ultrasound scan of left kidney showing large kidney stone
kidney stone in a child
CT scan in vertical axis showing stones in both kidneys
ultrasound for kidney stone
CT scan in transverse section showing both sided stones
Test for kidney stone
Operation room snapshot at MITR Hospital
ultrasound for kidney stone
The child is kept in prone position for Mini-perc

Facts about Endourology and urinary stones in children

Endourology involves surgeries within the urinary system through the natural channels or small holes using miniaturised telescopes.

Pediatric endourology had its advent 3 decades back with availability of Pediatric cystoscopes which can be used in small infants safely. Bets experts to use this technique are pediatric urologist doctors. Most common type of endourological surgeries in children are Posterior urethral valves ablation (case4), DJ stenting or for urinary stones.

Urinary stones in children are relatively uncommon and thus require thorough tests &investigation as to find the underlying factors leading to their occurrence, especially if they occur in kidney or ureter.

If the underlying cause can be identified, then medical therapy may be advisable to prevent reformation of stones. This is vital in kids as they have further 70-80 years of life ahead of them.

Small stones in kidney or ureters (<5mm) are generally passed spontaneously without any surgery, there are medicines which help in this. Rarely if the stone gets stuck in ureter it may require a Endourological Surgery in form of Ureterorenoscopy (URS).Bladder stones can sometimes form without any underlying metabolic disorder and they are treated separately by PCCL or Cystolithotripsy.

Dr A.K.Singal is a top Pediatric urologist based out of Navi Mumbai, India and does conduct treatment and surgery for Kidney stones for children. Children from all over Mumbai, Pune, Hyderabad, Bangalore, Delhi, Ahmedabad and 20 countries visit his clinic for best treatment for kidney stones in kids.

Watch video of Kidney Stone removal surgery by Dr Singal here: URS for ureteric stone in a child

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