Dr. DiBianco discusses miniPCNL in pediatric patients with kidney stones

Opinion
Video

"It's my opinion that no patient population benefits more from a miniaturized technique than a pediatric patient," says John Michael DiBianco, MD.

In this video, John Michael DiBianco, MD, discusses why a miniPCNL might be appropriate in a pediatric patient. DiBianco is an assistant professor of urology at the University of Florida, Gainesville.

Transcription:

Who is the ideal patient for pediatric miniPCNL?

It's my opinion that no patient population benefits more from a miniaturized technique than a pediatric patient, which kind of makes sense. If you think about how small the kidneys are, and previously in a lot of places, we use 30 French, very large bore access, compared to an adult-size kidney, typically, that transition and that difference, it was quite large. So, I think the patients that benefit the most are patients that have certain types of stones that potentially are much harder to treat with some of the more minimally invasive types of procedures like ureteroscopy, or shock wave lithotripsy. So large-volume stones, per the guidelines, and especially in the lower pole. In the lower pole, the kidney is a harder place to reach with certain scopes and doesn't drain as well. So some other techniques like shock wave lithotripsy offer a little bit less stone-free rates, are less efficacious. So a lot of patients, especially pediatrics, because they're so small, a lot of times have to undergo a lot of repeat procedures. Let's say you try to go and do a ureteroscopy, and the scope is too big. You can't fit it in the ureter, you put a stent in, so they have 1 anesthetic, and then they come back, and then you go up there, you try to take care of all the stone, maybe it's too hard, for whatever reason, you can't get all the stone on that trip, then you get another stent and you come back. A lot of the patients that we treat here have either had a couple of procedures beforehand, or they're at high risk of not being very successful with one of those other types of minimally invasive procedures: shock wave lithotripsy or ureteroscopy. And so a lot of my pediatric colleagues will reach out to me to see if they might be an appropriate candidate for miniaturized PCNL.

This transcription was edited for clarity.

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