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Percutaneous nephrolithotomy in the management of pediatric renal calculi
Sinan Zeren1, Nihat Satar, Yildirim Bayazit
1Department of Urology, Cukurova University, Faculty of Medicine, Adana, Turkey. szeren@mail.cu.edu.tr
Insights
Percutaneous nephrolithotomy (PCNL) is effective for pediatric kidney stones, achieving an 86.9% stone-free rate. Experienced urologists should consider PCNL for selected pediatric cases, especially SWL failures.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Management
- Surgical Interventions
Background:
- Extracorporeal shockwave lithotripsy (SWL) is common, but percutaneous nephrolithotomy (PCNL) remains necessary for select pediatric patients.
- Pediatric urolithiasis often stems from metabolic issues and UTIs, carrying recurrence risks.
- PCNL offers a solution for complex pediatric kidney stone cases.
Purpose of the Study:
- To review and discuss the experience with percutaneous nephrolithotomy (PCNL) in pediatric patients.
- To evaluate the efficacy and safety of PCNL in managing pediatric kidney stones.
- To assess the role of PCNL in cases refractory to SWL or with complex stone burdens.
Main Methods:
- A retrospective review of 67 PCNL procedures on 62 renal units in 55 pediatric patients (10 months-14 years) between 1997 and 2001.
- Patient selection included those with previous open surgery, solitary kidneys, SWL failures, and complex stone types (e.g., staghorn).
- Procedures utilized monoplane fluoroscopy, pneumatic or ultrasonic lithotripsy, and rigid nephroscopy or ureteroscopy.
Main Results:
- An 86.9% stone-free rate was achieved at discharge (53/62 renal units), with a 96.7% overall success rate.
- Six patients had insignificant residual fragments; one required open surgery, and another underwent SWL.
- No contiguous organ injury occurred, but 23.9% of procedures (16/67) involved intraoperative hemorrhage requiring transfusion.
Conclusions:
- PCNL is a viable option for selected pediatric urolithiasis cases, particularly those with metabolic abnormalities or recurrent stones.
- Urologists experienced in adult PCNL should consider this procedure for complex pediatric stone cases.
- Careful patient selection and experienced surgical teams are crucial for successful PCNL outcomes in children.
Background And Purposes:
In the era of extracorporeal shockwave lithotripsy (SWL), there are still some patients who will require percutaneous nephrolithotomy (PCNL). Our experience with this procedure is reviewed and discussed.
Patients And Methods:
Fifty five patients with a mean age of 7.9 years (10 months-14 years) underwent 67 PCNL procedures on 62 renal units between September 1997 and April 2001. Of the patients, 13 had previous open renal surgery, 4 had a solitary kidney, 4 were SWL failures, 2 had osteogenesis imperfecta, one had anuria secondary to bilateral calculi, 2 had poorly functioning kidneys, and 1 had cystinuria (complete staghorn calculus). One disabled patient with neurologic disorders who had multiple stones underwent PCNL in order to decrease the stone burden and to improve the kidney function. Operations were performed under the guidance of monoplane fluoroscopy. Pneumatic or ultrasonic lithotripsy and forceps extraction were used with a rigid nephroscope or ureteroscope (as an alternative instrument in small-caliber tracts).
Results:
Excluding the patient with neurologic disorders, 53 of the renal units (86.9%) were stone free at the time of discharge, and the success rate was 96.7%, with six patients having insignificant residual fragments after the procedure. In one patient, open surgery was required, and the other patient was sent for SWL treatment. There was no contiguous organ injury, but in 16 procedures (23.9%), intraoperative hemorrhage was seen, and blood transfusions were required.
Conclusion:
Pediatric urolithiasis is usually a result of metabolic abnormalities and urinary tract infection, and there is always a risk of recurrence that may necessitate multiple additional intervention. Therefore, PCNL must be considered in selected cases by urologists who are experienced in adult percutaneous procedures.