# Fluoroscopy-free mini-PCNL using CT–ultrasound fusion guidance in a pediatric patient with recurrent cystine stones: A case report

## TL;DR

A new radiation-free method for kidney stone removal in a child with cystine stones is described, using CT and ultrasound fusion guidance.

## Contribution

This case report demonstrates the feasibility of fluoroscopy-free mini-PCNL in pediatric patients using CT-ultrasound fusion guidance.

## Key findings

- Renal access and complete stone clearance were achieved in a 12-year-old boy using the fusion-guided approach.
- The procedure was completed safely with minimal blood loss and a 90-minute operative time.
- CT-ultrasound fusion guidance overcomes limitations of ultrasound-only methods in complex pediatric cases.

## Abstract

Pediatric patients are particularly susceptible to ionizing radiation risks. A fluoroscopy-free mini-percutaneous nephrolithotomy (mini-PCNL) was performed using computed tomography (CT)–ultrasound fusion guidance for recurrent cystine nephrolithiasis in a 12-year-old boy. Renal access and complete stone clearance were achieved. Integrating preoperative CT with real-time ultrasonography enabled precise targeting, overcoming limitations of ultrasound-only guidance. The procedure was completed safely, with minimal blood loss and 90-min operative time. CT–ultrasound fusion-guided mini-PCNL is a feasible radiation-sparing approach for pediatric patients with complex renal stones.