Complications of MPCNL for renal calculi in children and the managements

Abstract

In the past 10 years, we treated about 1500 children with renal calculi. Minimally invasive percutaneous nephrolithotomy (MPCNL) nowadays is the treatment of choice for most renal stones. To evaluate the occurrence and management of complications following minimally invasive percutaneous nephrolithotomy (MPCNL) for renal calculi in children. The clinical data of 158 children including 119 males and 39 females treated by MPCNL were reviewed from January 2010 to January 2018 in Hunan children’s hospital. The mean age was 6.65 years (range 6 months to 18 years). Of 158 cases, 41 cases had single renal calculus, 117 multiple renal calculi (25 cases were bilateral), and 11 cases with a history of ipsilateral lithotrity. The mean stone size was 23.53±7.25mm (range 15 to 43). The mean operative time was 58.6±15.8min (range 32 to 93). Stone-free rate was 82.9% (131/158) after a single procedure. 10 patients had insignificant fragments and were followed without any intervention; 17 required additional procedure (RIRS in 6, second MPCNL in 11) and 15 of these were completely stone free, resulting in an overall success rate of 92.4% three months later. The postoperative hospital stay was 6 days. 3 children suffered postoperative bleeding caused by laceration at the calyceal neck whose hemoglobin was as little as 65g/L and recovered after transfusion (Clavien Ⅱ). Renal vein trauma was caused by a deep puncture during the echo-guided PCN procedure in 2 cases, treated by clamping the nephrostomy catheter. 1 patient had to undergo superselective renal artery embolization for her uncontrollable bleeding (Clavien Ⅲ). Obvious urinary extravasation occurred in 2 cases, resolved by double J stent placement, anti-infection, hemostasis and other symptomatic treatment (Clavien Ⅱ). Delayed phase Ⅱ lithotripsy was carried out in 1 case because of failure in establishing the renal channel. Ureteropelvic junction obstruction was observed in 1 case at his postoperative visit and treated by ureterocalicostomy after diagnosis (Clavien Ⅲ). 14 patients had postoperative fever, treated with sensitive antibiotics (Clavien Ⅱ). There was a total of 24 complications (15.1%), with the most severe complications being Clavien Ⅲ. No patients showed urosepsis, abdominal visceral injury, pleural effusion, pneumothorax, and renal arteriovenous fistula and other severe complications. This data show that MPCNL is a safe and effective procedure for renal calculi in children. However, the complications cannot be ignored. Sufficient preoperative preparation and careful perioperative safety control should be required. Skillful and prudent operation, renal pelvic pressure control, monitoring life symptoms, levels of fluid, infection control and staged in select cases are the key to reducing and preventing complications.