Percutaneous nephrolithotomy in an 8-week-old infant

Area of Science:

• Pediatric Urology
• Nephrolithiasis Management
• Minimally Invasive Surgery

Background:

• Infants with congenital anomalies like myelomeningocele are susceptible to urinary tract infections and kidney stones.
• Large stone burdens (>2 cm) in solitary kidneys pose significant treatment challenges in infants.
• Conventional treatments like retrograde intrarenal surgery and shockwave lithotripsy are often unsuitable for very young patients.

Observation:

• An 8-week-old infant weighing 4.12 kg presented with a >2 cm stone burden in a solitary kidney.
• The infant had a history of thoracolumbar myelomeningocele and recurrent urinary tract infections.
• Stone analysis identified hydroxyapatite and carbonate apatite, with metabolic workup revealing hypercalciuria.

Findings:

• Successful percutaneous nephrolithotomy (PCNL) was achieved in this extremely young patient.
• The patient's small size and solitary kidney necessitated a tailored surgical approach.
• Post-operative management included chlorothiazide for hypercalciuria.

Implications:

• This case demonstrates the feasibility and safety of PCNL in very young infants with complex nephrolithiasis.
• It expands the potential treatment options for pediatric kidney stones, even in challenging solitary kidney cases.
• Highlights the importance of early intervention and tailored surgical strategies in pediatric urolithiasis.