Percutaneous nephrolithotomy for complex pediatric renal calculus disease

Pediatric renal calculus disease has been a management dilemma in view of the concern about the effects of the various treatment modalities on the growing kidney, the significant recurrence rate, and the long-term outcome. We report our experience with percutaneous nephrolithotomy (PCNL) monotherapy in staghorn or complex pediatric renal calculi.

We retrospectively analyzed the case records of 116 patients younger than 15 years who underwent PCNL. The stones included 56 complex calculi. We defined complex calculi as either staghorn (complete or partial) or those with a large bulk and involving more than one calix, the upper ureter, or both.

Complete clearance was achieved in 50 patients (89.8%). Of these, 22 (39%) required a single tract, while 34 (61%) required multiple tracts. With subsequent SWL, the clearance rate increased to 96%. The average hemoglobin drop was 1.9 g/dL. Assessing the factors affecting the hemoglobin drop, the number of tracts and the size of tracts were found to be significant (P<0.01). The average change in the serum creatinine concentration between the preoperative and postoperative measurements was +0.03 mg/dL and was not different in patients with a single tract and those with multiple tracts (+0.02 and +0.04 mg/dL, respectively; P=NS). Intravenous urography done in 36 renal units postoperatively revealed good function in all. A DMSA renal scan in six children showed no scar.

Monotherapy with PCNL is safe and effective in the management of staghorn and complex renal calculi in single hospital stay. Ultrasound-guided peripheral caliceal puncture and limiting the tract dilatation to 22F are important factors in reducing the blood loss. Multiple tracts increase the hemoglobin drop but are not associated with an increased risk of complications (bleeding, postoperative infection, and prolonged urinary leak). Also, there is no deterioration in renal function after either single- or multiple-tract PCNL.