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Percutaneous nephrolithotomy in children
R B Nerli1, Shridhar C Ghagane2, Amit Mungarwadi3
1Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-To-Be-University), JNMC Campus, Belagavi, Karnataka, 590010, India. rbnerli@gmail.com.
Insights
Percutaneous nephrolithotomy (PCNL) is a safe and effective treatment for pediatric kidney stones, achieving a 94.5% stone clearance rate. This minimally invasive procedure offers improved outcomes with low morbidity in children.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Management
- Minimally Invasive Surgery
Background:
- Percutaneous nephrolithotomy (PCNL) is a primary surgical treatment for large renal calculi in adults.
- PCNL is increasingly utilized for pediatric kidney stones, with rising indications.
- This study evaluates the safety and efficacy of PCNL in patients under 18 years old.
Purpose of the Study:
- To retrospectively assess the safety and efficacy of percutaneous nephrolithotomy (PCNL) in pediatric patients.
- To determine stone clearance rates and complication incidence in children undergoing PCNL.
- To evaluate PCNL as a management option for renal calculi in the pediatric population.
Main Methods:
- Retrospective review of inpatient and outpatient records, and imaging films.
- Analysis of data from children undergoing PCNL for renal stones at a single center.
- Data collection included patient demographics, stone characteristics, surgical approach, and outcomes.
Main Results:
- 123 children underwent 129 PCNL procedures for renal calculi.
- Mean patient age was 11.06 years, with 70.73% males.
- Stone clearance was achieved in 94.5% of cases, with 3.1% requiring blood transfusion for bleeding.
Conclusions:
- Advancements in PCNL techniques and instruments have improved outcomes and reduced morbidity in children.
- PCNL is a safe and effective procedure for clearing large volumes of renal calculi in pediatric patients.
- The study supports PCNL as a minimally invasive option with low complication rates for pediatric kidney stones.
Introduction:
The high success rates of percutaneous nephrolithotomy (PCNL) in the clearance of large renal calculi has made it a primary mode of surgical management in adults. Similarly, in children too PCNL has been gaining ground and the indications for the same are on the rise. We retrospectively evaluated the safety and efficacy of this technique, in children below 18 years of age.
Materials And Methods:
We retrospectively reviewed the inpatient, outpatient records, imaging films of all children with renal stones undergoing PCNL at our hospital.
Results:
During the study period, 123 children underwent 129 PCNL at our centre for renal calculi. The mean age was 11.06 years and 87 (70.73%) of the children were males. The size of the stones varied from 15 to 37 mms in the longest diameter. A complete staghorn was noted in six (4.65%) and a partial staghorn in nine (6.97%) children. Supine PCNL was performed in 21 (16.2%) children and remaining 102 (83.7%) children underwent PCNL in prone position. The mean drop in haemoglobin was 1.24 gm%. Stone clearance was achieved in 122 (94.5%) children. Post-operatively four (3.1%) children needed blood transfusions due to excessive bleeding.
Conclusions:
Refinements in percutaneous access techniques, miniaturization of instruments, and technologic advances in energy sources for lithotripsy have led to improvement of outcomes and have lowered the morbidity rates in children following PCNL. It is a safe and effective means of clearing large volumes of renal calculi with minimal morbidity.
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