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A. Frattini, S. Ferretti, A. Salvaggiothe right calyx for the percutaneouspuncture (Endovision° procedure).The direct control of needle’s perforationof renal papilla confirmsor excludes the correct biplanarx-ray guidance and allows also ashorter X-ray exposure time duringthe construction of the percutaneousnephrostomy access. In7/9 patients an Endovision° procedurewas successfully carriedon. LASER and ballistic probeswere used for lithotripsy. In 6cases a 12 Fr nephrostomydrainage was left in place at theend of the procedure, in 7patients a 16 Fr and in 2 patientsa 20 Fr, respectively. In 4 cases we performed a tublessprocedure.RESULT14/15 patients were stone-free (13 pts in one time, 1 pt in2 procedures and 1 pt, with complete bilateral stones disease,in 5 endourological essions). Stone compositionwas: phosphate ammonium and magnesium in 2 cases,oxalate in 8, phosphate in 4 and phosphate-oxalate in 1patient (Figure 1). Generally, the ureteral mono-J wasremoved 24 hours posteperatively and the nephrostomytube after an average of 4,7 ± 2,7 days (range: 2-11 days).Complications were: 1 prolonged haematuria from thenephrostomy tube needing a blood transfusion, 4 casesof fever, in 1 case pain secondary to oedema of theureteral meatus that requested the application of anureteral stent.n. patients (15)Phos/Am/MgFigure 1.Stone composition.OxalateStone CompositionPhosphateOx/PhospDISCUSSION AND CONCLUSIONIn adults as in children, the supine position carries severaladvantages: optimal decubitus can be assumed by theawake patient by himself, no risk of traumatisms due tobed-position (standard prone procedure); no thoraciccompression, reduced colon perforation risk; contemporaryantegrade and retrograde access to the urinary tract.Retrograde ureteroscopy and antegrade percutaneousnephroscopy with rigid and flexible instruments (1),make clearance of stone fragments easier, even in very difficultcases and reduce also the necessity of multiple renalaccesses and secondary procedures (e.g. extracorporeallithotripsy on residual fragments). During LASERlithotripsy, the irrigation through the ureteral way allowsthe clearing of the stone fragments for gravity through thenephrostomy and maintains low intrarenal pressures duringsurgical time. When it’s possible tubless procedure ispreferred for less discomfort in postoperative time.It’s important to consider that in children even a minorblood loss could be engaging. Nevertheless, we believethat percutaneous nephrolithotripsy in paediatric age, ifcorrectly performed, is a safe, effective and feasible procedure(2). And it is less invasive compared to open surgery(3).Our take home message is that we believe that theendourological approach is better than traditional opensurgery or reiterated extracorporeal shock wave lithotripsysessions which often need anaesthesia and can notguarantee a complete clearance of the stones.REFERENCES1. Frattini A, Ferretti S, Salsi PE, et al. Minipercutaneous procedure(MIPP): a new set. Archivio Italiano di Urologia e Andrologia 2007;79-3(suppl. 1):43-46.2. Hogan MJ, Coley BD, Jayanthi VR, et al. PercutaneousNephrostomy in Children and Adolescents: OutpatientManagement. Radiology. 2001; 218:207-210.3. Ozden E, Sahin A, Tan B, et al. Percutaneous renal surgery inchildren with complex stones. J Pediatr Urol, 2008; 4:295-98.CorrespondenceAntonio Frattini, MDO.U. Urology - Azienda Ospedaliero-Universitaria of ParmaVia Gramsci 14 - 43100 Parma, ItalyStefania Ferretti, MDO.U. Urology - Azienda Ospedaliero-Universitaria of ParmaVia Gramsci 14, 43100 Parma, ItalyAntonio Salvaggio, MDO.U. Urology - Ospedale SaccoVia G.B. Grassi 74 - 20157 Milano, Italy52Archivio Italiano di Urologia e Andrologia 2010; 82, 1