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Percutaneous nephrolithotomy for complex pediatric renal calculus disease
Mahesh R Desai1, Rajesh A Kukreja, Snehal H Patel
1Department of Urology, Muljibhai Patel Urological Hospital, Gujarat, India. mrdesai@mpuh.org
Journal of Endourology
|March 10, 2004
Summary
Percutaneous nephrolithotomy (PCNL) is a safe and effective treatment for pediatric complex kidney stones. This monotherapy achieved high clearance rates with no significant impact on renal function.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Management
- Minimally Invasive Surgery
Background:
- Pediatric renal calculus disease presents management challenges due to concerns about growing kidney effects, high recurrence rates, and long-term outcomes.
- Percutaneous nephrolithotomy (PCNL) is explored as a monotherapy for complex pediatric kidney stones.
Purpose of the Study:
- To evaluate the safety and efficacy of PCNL monotherapy in children with staghorn or complex renal calculi.
- To assess factors influencing outcomes and complications associated with PCNL in pediatric patients.
Main Methods:
- Retrospective analysis of 116 pediatric patients (<15 years) undergoing PCNL for renal calculi.
- Complex calculi defined as staghorn or large stones involving multiple calices/upper ureter.
- Ultrasound-guided peripheral caliceal puncture and tract dilatation limited to 22F.
Main Results:
- Complete stone clearance achieved in 89.8% of patients with PCNL monotherapy; 96% with subsequent SWL.
- Hemoglobin drop was associated with the number and size of tracts (P<0.01).
- No significant change in serum creatinine or deterioration in renal function observed post-PCNL.
Conclusions:
- PCNL monotherapy is safe and effective for pediatric staghorn and complex renal calculi, allowing for a single hospital stay.
- Ultrasound guidance and limited tract dilatation (22F) are key to reducing blood loss.
- Multiple tracts increase hemoglobin drop but do not elevate complication risks; renal function remains preserved.