Safety and efficacy of a superior caliceal puncture in pediatric percutaneous nephrolithotomy

Access through the superior calix for percutaneous nephrolithotomy (PCNL) often breaches the diaphragm and is believed to have greater complications than access through other calices. We evaluated the safety and efficacy of a superior caliceal access in pediatric patients who were undergoing PCNL.

Operative and recovery data for pediatric patients (up to 16 years old) who were undergoing PCNL for renal calculi were prospectively entered into a database and reviewed. Patients with a superior calix puncture were compared with those in whom the superior calix was not punctured. Stone clearance was assessed by intraoperative fluoroscopy and postoperative radiography in all patients and ultrasonography and CT scan in selected cases.

Over a 2-year period, 26 pediatric patients (mean age 11.12 years; range 4-16 years) underwent 27 PCNLs. Stone bulk ranged from 200 to 1150 mm² (mean 656.03 mm²). Nine patients had staghorn stones. Thirteen patients (14 renal units) had primary superior calix access with 13 of these being supracostal (above the 12th rib). Four of these had staghorn calculus. All stones were fragmented using a pneumatic lithoclast. Second-look PCNL was necessary in two patients. Complete clearance was achieved in all except one patient in each group with superior and nonsuperior caliceal puncture. Hydrothorax developed in one patient with supracostal puncture necessitating tube drainage while abdominal collection developed in one in patient who underwent the nonsuperior calix approach. Both patients recovered with no sequelae.

The superior calix puncture is safe and effective in the pediatric population.