[The surgical treatment of staghorn nephrolithiasis in children and its effect on kidney function]

Area of Science:

• Pediatric Urology
• Nephrology
• Surgical Outcomes

Background:

• Coral nephroliths (kidney stones) are complex and challenging to treat in children.
• Surgical interventions like nephrolithotomy are sometimes necessary when less invasive methods fail or are contraindicated.
• Understanding the impact of different surgical approaches on renal function is crucial for pediatric patients.

Purpose of the Study:

• To evaluate the functional outcomes of dynamic nephroscintigraphy in children with coral nephroliths.
• To compare sectional and partial nephrolithotomy in pediatric patients with complex kidney stones.
• To determine the indications for sectional nephrolithotomy in cases of significant preoperative renal deficiency.

Main Methods:

• Dynamic nephroscintigraphy was performed on 29 children (ages 5-15) pre-surgery and post-surgery (6-24 months).
• Patients underwent either sectional nephrolithotomy (22 cases) or partial nephrolithotomy (7 cases).
• Renal function was assessed using scintigraphy findings.

Main Results:

• Reduction in renal function after sectional nephrolithotomy was inversely proportional to the preoperative functional deficit.
• Partial and sectional nephrolithotomy were deemed justifiable for coral/multiple nephroliths only if extracorporeal impulse lithotripsy was contraindicated.
• Sectional nephrolithotomy was indicated for coral nephroliths when initial renal function deficiency exceeded 50%.

Conclusions:

• The degree of renal function loss post-sectional nephrolithotomy correlates with the initial kidney function.
• Surgical nephrolithotomy in children should be reserved for cases where extracorporeal lithotripsy is not feasible.
• Sectional nephrolithotomy is a viable option for pediatric coral nephroliths with significant preoperative renal impairment (>50%).