Okul Çağı Öncesi Çocuklarda Perkütan Nefrolitotomi Sonuçları: Tek Merkez Deneyimi

Abstract

Objective: Kidney stones are an important urological problem in both adults and children. They may be accompanied by metabolic disorders and genetic diseases and children make up approximately 20% of stone patients in our country. In our clinic, we evaluated the results from pre-school children 6 years of age and younger who underwent percutaneous nephrolithotomy (PNL) surgery. Material and Methods: Between March 2012 and June 2016, 54 pediatric patients aged 0-6 years were treated with PNL for stones that were larger than 2 cm or ESWL-resistant, after undergoing the appropriate tests at the Urology Department of the Harran University Faculty of Medicine. PNL operations were performed under general anesthesia. After cystoscopy in the supine position, a ureteral catheter was inserted, accompanied by C-arm fluoroscopy. Afterwards, the patients were placed in the prone position before the kidney was entered using a metal needle with a fluoroscopy attachment. We dilated the entrance with amplatzer renal dilators and entered with a 17 fr nephroscope. After the procedure, the nephrostomy catheter was placed in the renal sheath. 4 mm residual fragments remaining after the operation were accepted as clinically insignificant stone residues. Results: A total of 54 patients underwent PNL operations; 23 females and 31 males. The mean age was 3.16± 0.8. 25 left-sided and 29 right-sided procedures were used. Three patients had bilateral kidney stones; co-administration was not staged. Mean stone size was 370±45 mm2, while the mean operation time was 55 ± 21 minutes. 45 (83.3%) of the patients were stone-free after the operation. Postop, 2 (3.7%) had free fluid and ileus and 6 (11.1%) required additional blood products. They were stabilized with additional JJ stents. After a nephrostomy drain, 4 (7.4%) patients had a JJ stent inserted. Average duration of the nephrostomy was 3.1 ± 0.9 days. Conclusion: As with every age group, PNL was effective in treating stones larger than 2 cm as well as smaller ESWL-resistant specimens. Success in preschool children is practically guaranteed, with a minimally invasive surgical procedure.