Minimally invasive percutaneous nephrolithotomy for complex renal calculi in children

Abstract

Objective To retrospectively analyze the safety and efficacy of minimally invasive percutaneous nephrolithotomy (MPCNL) for complex pediatric renal calculi.Methods Thirty-three patients including 21 boys and 11 girls, who underwent MPNCL for complex renal stones, were recruited in this study.Their ages ranged from 5 to 14 years (mean:8.5±2.3 years).Of the 33 patients, 16 had calculi in right kidneys and 13 in left kidneys, and 4 had bilateral renal calculi.Eleven patients had single calculus, 19 had multiple calculi, and 3 had staghorn stones.The stones' size ranged from 2.1 cmX3.2 cm to 3.7 cmX6.7 cm.The calculi were positioned by ultrasonography and treated with MPCNL.Operating time, stone free rate and complications were recorded and analyzed retrospectively.Results The pelvicaliceal system was successfully approached on all patients.Of the 33 patients, 29 required a single tract, the other 4 required multiple tracts.Four cases underwent simultaneons bilateral MPCNL.Thirty one patients underwent lithotripsy in one stage, and the other 2 patients underwent lithotripsy in 2 stages.The operative time ranged from 80 to 130 min with an average of 92 min.The mean operative blood loss was 61.5±12.3 ml (range, 30-80 ml).No blood transfusion was performed.No severe complications were noted after MPNLC.The overall stone-free rate was 96.9% (32/33).Residual stone fragments were found in 1 patient who underwent adjuvant extracorporeal shock wave lithotripsy.The postoperative hemoglobin and creatine stayed at the same level with the preoperative measurements.Average hospital stay was 5.4 days (range, 4-8 days).Mean follow-up period was 9 months (range, 3-18 months).No calculi recurrence was noted.Conclusions MPNCL is a safe and effective management for complex pediatric renal calculi, It deserves the first choice for complex pediatric renal calculi. Key words: Renal calculi; Surgical procedures,minimally invasive; Lithotripsy