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Mini PCNL: A viable single stage treatment for pediatric nephrolithiasis in resource limited countries
Omer Farooq Rehman1, Azhar Khan2, Hannah Harvey2
1Armed Forces Institute of Urology, Rawalpindi, Pakistan.
Insights
Mini percutaneous nephrolithotomy (PCNL) offers effective single-stage treatment for pediatric kidney stones. This minimally invasive procedure achieves high stone clearance rates with an acceptable risk of complications, making it a valuable option for children.
Area of Science:
- Urology
- Pediatric Surgery
- Nephrology
Background:
- Increasing enthusiasm for mini percutaneous nephrolithotomy (PCNL) in pediatric stone management.
- Need for single-stage treatment in developing countries due to poor compliance with repeat treatments like SWL.
- Assessing the safety, feasibility, and outcomes of mini PCNL in children is crucial.
Purpose of the Study:
- To evaluate the safety and effectiveness of mini PCNL for pediatric kidney stone clearance.
- To determine the stone clearance rate and complication profile of mini PCNL in a pediatric cohort.
- To assess the feasibility of mini PCNL as a single-stage treatment option for pediatric urolithiasis.
Main Methods:
- Retrospective analysis of 113 pediatric patients (135 procedures) undergoing mini PCNL between December 2016 and December 2019.
- Data collected included stone size, clearance rate, complications (Clavien Classification), fluoroscopic exposure, operative time, and hospital stay.
- Postoperative follow-up imaging at 1 and 3 months assessed stone-free status.
Main Results:
- Primary stone clearance achieved in 91.1% of patients, with a secondary clearance rate of 97.0% after ancillary procedures.
- Mean operative time was 63.8 minutes, and mean hospital stay was 4.3 days.
- Complications occurred in 16.3% of patients; metabolic abnormalities (hypocitraturia, hypercalciuria) were noted in 56.7%.
Conclusions:
- Mini PCNL is an effective single-stage treatment for definitive pediatric kidney stone clearance.
- The procedure demonstrates an acceptable risk of complications in the pediatric population.
- Findings support the utility of mini PCNL for managing pediatric urolithiasis, particularly in settings requiring single-stage intervention.
Introduction:
There is increasing enthusiasm for the value of mini PCNL for pediatric stone clearance. In developing countries, it is important to arrange a single stage treatment as a significant proportion of patients do not comply with repeated treatments, such as SWL.
Objective:
To assess the safety, feasibility and outcomes of Mini PCNL in a pediatric cohort.
Materials And Methods:
Retrospective analysis was performed of all paediatric patients undergoing Mini-PCNL at our institute between December 2016 and December 2019. Data was collected on stone size, stone clearance rate, complications, fluoroscopic exposure, mean procedural time and length of hospital stay. Follow up data included imaging to assess stone free status at 1 and 3 months postoperatively.
Results:
Mini PCNL was performed in 113 pediatric patients, a total of 135 procedures, accounting for bilateral disease in 22. The age range was from 1 to 14 years with a mean age of 8.45 ± 3.14 years. The mean stone burden was 2.1 ± 0.4 cm. Partial and complete staghorn stones were observed in 7 and 3 patients, respectively. The mean operative time was 63.8 ± 13.2 min (range: 25 min to 116min) and mean length of stay was 4.3 ± 2.2 days. Primary stone clearance was achieved in 91.1% (123 patients). Ancillary procedures were undertaken in 10 patients resulting in a secondary clearance rate of 97.0% (131 patients) at 3 months. Complications occurred in 16.3% (22 patients) using the modified Clavien Classification. Metabolic abnormalities were seen in 56.7% of patients with hypocitraturia and hypercalciuria being the most common abnormalities.
Discussion:
Our study reports a clearance rate of 91.1%, whereas, Zeng et al. documented a stone clearance rate of 80.4%. This contrast may be attributed to the difference in followup imaging protocols of the two studies and the energy source used for fragmentation. The incidence of complications with PCNL ranges from 10.6% to 36.3%, we found complications in 16.3% of our cohort. Our study is limited due to its retrospective design with a short follow-up protocol. Computed tomography being gold standard for qualitative and quantitative assessment of stone burden was not used in all patients to assess the preoperative stone size. Furthermore, postoperatively stone clearance was determined on the basis of ultrasound and x-ray films that could limit the accuracy of our stone clearance rate.
Conclusion:
Our study suggests that mini PNCL in pediatrics patients is an effective single stage treatment for definitive stone clearance with an acceptable complication risk.
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