Supine mini PCNL in infants using conventional cystoscope

This report presents a simplified technique for supine mini percutaneous nephrolithotomy (PCNL) in infants using a conventional compact cystoscope. This approach utilizes instruments commonly available in pediatric urology, enhancing accessibility in resource-limited settings.

After informed consent and under general anaesthesia (GA), the patient was placed supine with flank elevation. Legs were kept apart as extended lithotomy so that a 3Fr ureteric catheter could be placed retrograde via cystoscopy. Under fluoroscopy,the lower/mid calyx was punctured,14Fr Amplatz sheath, trimmed to 10 cm, inserted using one-step dilator. A 9Fr Olympus compact cystoscope (4.2Fr channel) was used to dust the stone using Holmium:YAG laser (325-μm); DJ stent was inserted antegrade in all patients to aid fragment clearance and' removed after 4 weeks under GA.

Between 2023 and 2025, Five infants (median age 15 months) with single pelvic stones (13-19 mm) underwent the procedure. Mean operative time was 40 min. No complications occurred. All had complete clearance at 1-year follow-up.

This modified mini PCNL approach reduces invasiveness and enhances recovery. The supine position improves anesthetic safety and eliminates the need for repositioning. Supporting literature confirms the safety and efficacy of miniaturized PCNL techniques in infants. Further studies are needed to validate long-term outcomes.