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Efficacy and Safety of Percutaneous Nephrolithotomy in Children: A Single-Center Retrospective Analysis
Madan Gopal Bhardwaj1,2, Lalit Kumar1, Yashasvi Singh1
1Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND.
Insights
Percutaneous nephrolithotomy (PCNL) effectively cleared pediatric kidney stones with low complications. Recurrence in children may be linked to urine hydration and metabolic factors, warranting further investigation.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Management
- Surgical Outcomes
Background:
- Pediatric urolithiasis incidence is rising globally.
- Percutaneous nephrolithotomy (PCNL) is the primary treatment for complex pediatric stones.
- Limited long-term data exists on recurrence predictors after pediatric PCNL.
Purpose of the Study:
- To assess the safety and efficacy of PCNL in pediatric patients.
- To identify predictors of stone recurrence following PCNL.
- To evaluate outcomes at a tertiary care center in northern India.
Main Methods:
- Retrospective analysis of 27 children (≤14 years) undergoing PCNL.
- Evaluation of pre-operative parameters, stone burden (Guy's Stone Score), and stone composition.
- Assessment of post-operative outcomes, complications, and recurrence over a mean follow-up of 37.5 months.
Main Results:
- Complete stone clearance was achieved in all patients with a mean hospital stay of 3 days.
- Calcium oxalate stones were most common (66.7%).
- Recurrence occurred in 22.2%, associated with acidic urine and low specific gravity, though not statistically significant in multivariate analysis.
Conclusions:
- PCNL is a safe and effective procedure for pediatric kidney stones, achieving high stone clearance rates.
- Hydration and metabolic factors, indicated by urine pH and specific gravity, may influence recurrence.
- Further research with larger cohorts is needed to confirm recurrence predictors in pediatric PCNL.
Introduction:
Pediatric urolithiasis is increasing globally, with metabolic and environmental factors contributing to recurrence despite advances in minimally invasive surgery. Percutaneous nephrolithotomy (PCNL) is now the preferred treatment for large or complex stones in children, yet long-term data on metabolic predictors of recurrence remain limited.
Objective:
This study aims to evaluate the safety, efficacy, and recurrence predictors following PCNL in pediatric patients at a tertiary center in northern India.
Study Design:
A retrospective analysis was conducted on 27 children (≤14 years) who underwent PCNL between January 2021 and May 2023. Preoperative demographic, biochemical, and radiological parameters were recorded. Stone burden was assessed using CT urography or NCCT (non-contrast computed tomography) and graded by Guy's Stone Score (GSS). Standard or mini-PCNL techniques were selected based on stone characteristics. Postoperative biochemical changes, stone composition, outcomes, and recurrence over two years were evaluated.
Results:
The mean age was 8.8 ± 3.4 years (range 1-14), with a male-to-female ratio of 1.7:1. GSS Grade 2 stones predominated (59.3%), with a mean size of 1.9 ± 0.6 cm. Complete clearance was achieved in all patients, with a mean hospital stay of 3 ± 1 days. Hemoglobin decreased by 0.81 g/dL (p = 0.016), while creatinine remained unchanged. No major complications occurred; minor Clavien-Dindo I-II events were seen in 44.4%. Calcium oxalate stones accounted for 66.7%. At a mean follow-up of 37.5 months, recurrence occurred in 22.2%, mainly in children with acidic urine and low specific gravity. Multivariate analysis revealed no independent predictors, although urine pH and specific gravity showed predictive trends.
Conclusion:
PCNL demonstrated favorable stone clearance with acceptable morbidity in this cohort. Recurrence appeared to be influenced by hydration and metabolic factors, although conclusions are exploratory due to the small sample size.
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