Introduction. Contact lithotripsy is a modern minimally invasive procedure. It is used to treat kidney stones in pediatric urology using laser, pneumatic and ultrasonic methods.
The aim of the study is increasing the effectiveness of percutaneous nephrolithotripsy in children using various types of contact lithotripters.
Material and methods. Between 2008 and 2024, 502 patients (aged 1–17 y/o) underwent percutaneous nephrolithotripsy (PNL) at the Department of Pediatric Urology of N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology – Branch of the National Medical Research Radiological Centre. Patients were divided into three groups depending on the size of the used instruments and the contact lithotripsy method. The first group (n=322) underwent surgery using the 15–16Ch mini PNL technique. The second group (n=20) underwent surgery using the ultra-mini PNL technique and the third group (n=17) underwent surgery using the standard PNL technique with 24Ch nephroscope (n=160). The procedure was performed using standard methods; all children underwent cystoscopy, ureteral catheterization, percautaneous access, lithotripsy, lapaxy, and nephrostomy drainage.
Results. Complete elimination of clinically significant size stones was achieved after the primary procedure in 258 (80.2%) patients of the first study group, in 18 (90%) patients in the second group and in 126 (78.7%) patients went stone free. Laser lithotripter was used in 44.5% (143 patients) in the mini PNL group, pneumatic lithotripsy was performed in 50.9% (164 patients) and ultrasonic one – in 4.6% (15 children). In the ultra-mini PNL group laser lithotripter was used in 100% of cases. In the third group with a standard-size nephroscope, laser lithotripter was used in 20% (32 children), pneumatic lithotripsy in 23.1% (37 children), and ultrasonic lithotriptsy in 56.9% (91 children).
Conclusion. The choice of contact lithotripter is limited by the size of the instrument used, the density and chemical composition of stones. Only a laser contact lithotripter can be used in ultra-mini PNL due to the small size of the working channel of the instrument (12 Ch nephroscope sheath). The use of an ultrasonic lithotripter through the working channel of a mini-nephroscope is difficult due to frequent obstruction of the of the lithotripter sonotrode aspiration channel by small fragments of the stones at the litholapaxy stage. Dense stones, 1200 HU and higher, should be destroyed using pneumatic and laser contact lithotripsy. It is advisable to destroy cystine and xanthine stones using a pneu¬matic lithotripter because of their soft waxy structure.
