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Does percutaneous nephrolithotomy in children cause significant renal scarring?
Lubna Samad1, Samia Qureshi, Zafar Zaidi
1Division of Urology, The Kidney Centre Postgraduate Training Institute, 197 Rafiqui Shaheed Road, Karachi 75530, Pakistan.
Journal of Pediatric Urology
|October 25, 2008
Summary
Percutaneous nephrolithotomy (PCNL) in children can cause focal renal parenchymal damage, particularly from tract formation. Careful technique and smaller instruments may minimize this risk, but long-term monitoring is needed.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Management
- Renal Imaging
Background:
- Percutaneous nephrolithotomy (PCNL) is a common procedure for pediatric kidney stones.
- Assessing potential renal parenchymal damage post-PCNL is crucial for long-term outcomes.
Purpose of the Study:
- To evaluate the incidence of renal parenchymal damage after PCNL in pediatric patients.
- To investigate the association between PCNL tract formation and observed renal damage.
Main Methods:
- Prospective study of 56 children (60 renal units) undergoing PCNL.
- Postoperative renal function assessed using technetium-99m dimercaptosuccinic acid ((99m)Tc-DMSA) scans.
- Data collected on stone characteristics, procedure details, and outcomes.
Main Results:
- Cortical defects were observed on (99m)Tc-DMSA scans in 17% of renal units.
- Focal renal damage correlated with the PCNL access tract in some cases.
- No association found between renal damage and the size of the nephroscope used.
Conclusions:
- Nephrostomy tract formation during PCNL poses a risk of focal renal parenchymal damage in children.
- Meticulous surgical technique and potentially smaller instruments can help mitigate this risk.
- Long-term follow-up is necessary to determine the permanence of renal scars.
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