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Abstract

In the pediatric age group, the occurrence of renal stones is often associated with anatomic abnormalities, metabolic disorders, or urinary tract infections and the risk of recurrence is high. These factors make minimally invasive procedures more important in this age group. In the last decade, technological advancement and miniaturization of instruments has changed the management of pediatric urinary stone disease. Percutaneous nephrolithotomy (PCNL) is a well-established procedure in adults with advantages such as a small skin incision, less pain, short hospital stay, and reduced severity or risk of complications. PCNL with adult-sized instruments may present problems in infants and preschool age children because of small size and mobility of the pediatric kidney, friable renal parenchyma, and the small size of the collecting system. In this study, we compared the morbidity and success rates among different age groups of children undergoing PCNL using adult or pediatric sized devices. We divided the patients into 3 groups, with group 1 children younger than 8 years, while children in groups 2a and 2b aged 8-16; group 2a children required pediatric instrumentation and adult-sized nephroscopes were used in group 2b children. There was no major complication and deaths in our series. Most of the complications were pain, bleeding, urinary leakage after removal of the nephrostomy tube, and postoperative fever. One of the factors responsible for bleeding was the degree of dilation of the tract; less postoperative bleeding occurred when the degree of dilation was less. There was a greater decrease in hemoglobin level when the tract was dilated to 24F or more (group 2b). The mean time to access the collecting system, mean operative time, and average postoperative hospital stay did not differ between the groups. Smaller instrument size did not increase the operative time, and resulted in the same success rates as the adult sized devices. Stones were completely cleared in 82.4%, 83.3%, and 81.3% of patients, which increased to 94.1%, 91.7%, and 93.7% with adjunctive shock wave lithotripsy and ureterorenoscopy in groups 1, 2a, and 2b, respectively. Endourologic intervention to children usually requires instruments specific for preschool age, yet in older children the use of the same instruments and technique as in adults may achieve equal results without any increased risk of possible morbidity and need of blood transfusion. When the collecting system is not dilated, the instruments used in adults may be traumatic because of their size. In conclusion, PCNL is a safe and effective procedure for renal stones, with no limitations to age. Editorial CommentUrologyVol. 76Issue 1PreviewThis is an interesting series of percutaneous nephrostolithotomies in 45 renal units in the pediatric age group. The author(s) divide their patients into 3 groups, with group 1 representing children younger than 8 years of age, whereas groups 2a and 2b were ages 8-16, with 2a requiring pediatric instrumentation and 2b using adult-sized nephroscopes. Their stone-free clearance rates (81%-83% with percutaneous techniques, 92%-94% with combined percutaneous and ESWL therapy) were quite good and comparable to those reported in other series. Full-Text PDF