Pediatric percutaneous nephrolithotomy using adult sized instruments: our experience

Area of Science:

• Pediatric Urology
• Nephrolithiasis Management
• Minimally Invasive Surgery

Background:

• Pediatric urolithiasis presents unique management challenges.
• Percutaneous nephrolithotomy (PCNL) is an established treatment for large or complex kidney stones.
• The use of adult-sized instruments in pediatric PCNL requires safety and efficacy evaluation.

Purpose of the Study:

• To assess the safety and efficacy of pediatric percutaneous nephrolithotomy (PCNL) utilizing adult-sized instruments.
• To evaluate outcomes in children undergoing PCNL for urolithiasis with standard or tubeless techniques.

Main Methods:

• Retrospective review of 38 children (<15 years) undergoing 45 PCNL procedures with adult instruments (August 2007-February 2010).
• Analysis of patient demographics, stone burden, operative details (including simultaneous procedures), and postoperative outcomes.
• Comparison of hospital stay between standard and tubeless PCNL groups.

Main Results:

• A 67% stone clearance rate was achieved in pediatric patients.
• Mean stone burden was 2.93 cm; 12 patients had staghorn calculi.
• Complications were minimal, including one case of hyponatremia/seizure and one blood transfusion; postoperative fever occurred in 8 patients. Tubeless PCNL showed a significantly shorter hospital stay (P < .02).

Conclusions:

• Pediatric PCNL with adult-sized instruments is a relatively safe and effective option for urolithiasis management.
• A 67% stone clearance rate was observed.
• Prospective studies comparing mini-PCNL and adult-sized instruments in pediatric PCNL are warranted.