Expert shares pearls on performing miniPCNL in pediatric patients
"You definitely need to be very adaptable. You have to have a great team," says John Michael DiBianco, MD.
In this video, John Michael DiBianco, MD, shares pearls on performing miniPCNL in pediatric patients. DiBianco is an assistant professor of urology at the University of Florida, Gainesville.
Transcription:
What are some pearls regarding miniPCNL in pediatric patients that you'd like to share?
The biggest thing that I tend to want to dispel is that this is a very invasive and a very dangerous procedure, which is one of the reasons why in the pediatric population, I tend to see that patients don't typically get the most effective procedure. They tend to get minimally invasive, potentially less effective procedures and several of them. It's not because people don't want to do the right thing for the patient. It's because they're worried and when people are small, we don't want anything to go wrong, and it's a very good reason. But what I would tell you is that multiple procedures is not without its risks as well. And the more procedures in the ureter, the potential there is for scar tissue down the line or more suffering with a stent for a longer periods of time. And so I think what's really nice about these minimally invasive PCNL procedures is that they've been shown, especially in adults, to decrease complications compared with maximally invasive PCNL procedures, for sure, but even sometimes compared with ureteroscopy. The fact that we're getting smaller and smaller and keeping some that efficacy is very helpful for patients, and I think, at least at this point, is helping us to provide evidence that it can be done safely. And that's the biggest thing that I typically want to dispel - this idea that anything we do through the back is associated with those older methods of percutaneous nephrolithotomy and that has everybody's attention and maybe some fear. But I would say that you definitely need to be very adaptable. You have to have a great team, a great pediatrics team and great pediatric colleagues if you're not a pediatric urologist yourself. You need to have great anaesthetic team, very supportive, and you need to have a wide variety of tools available in case something unexpected comes up like a UPJ obstruction or ectopic ureter or something, because unfortunately these kids make stones for a reason, and you just have to be ready to handle the unexpected.
This transcription was edited for clarity.
