Percutaneous Nephrolithotomy (Pcnl) in Paediatric Stones: A Single Centre Experience

Abstract

Purpose In Pakistan there is a high prevalence of Urolithiasis both in adults as well as in children. Minimally invasive techniques for the treatment of urinary calculi in children are recommended due to an increased probability of stone recurrence. Percutaneous nephrolithotomy (PCNL) is an established technique used in children with renal calculi. We report our experience with PCNL for treating nephrolithiasis in children. Material and Methods Clinical records of children who underwent PCNL procedures for renal calculi from June 2004 to June 2009 were reviewed. A total of 500 children with renal calculi were treated with PCNL. Patients had pre-operative blood and urine analysis, ultrasonography of kidneys, ureter, bladder and X-ray IVU or CT KUB. Tract was made in prone position using fluoroscopy and ultrasound. 22 to 26 Fr sheaths with 18.0, 20.5 and 24 Fr nephroscope were used accordingly. Ultrasound and pneumatic lithoclast alone or in combination were used for stone fragmentation.variabe assesed included patient's age, sex and stone burden. PCNL route, calyceal access and number of tracts also recorded.we reviewed operative time, Hb drop, stone clearance and complications. Results 500 PCNL procedures were performed. Patient's age at operation ranged from 8 months to 15 years with 35% children of pre school age group (≤ 5 years of age). M: F ratio of 2.3: 1. Stone burden ranged from 3.1 ± 3.7 cm2 with stone clearance rates of 89% with monotherapy. During the procedure mean Hb drop was 1.36 ± 0.8 gm% while 14.6% patients required blood transfusion. Intra and post operative complications included conversion to open surgery in 2.6% (due to failed tract or excessive bleeding), extravasation of fluid in 3.6% and uro sepsis in 1.6%. Conclusions Percutaneous nephrolithotomy is a suitable and safe procedure in children including pre-school age group for both simple and complex stones.