Evaluation of the efficacy and safety of percutaneous nephrolithotomy in children

Madhusudhan Reddy; Arunkumar Annamalai; Irshad Ali; Dheeraj Soma Siva Sajja; Rahul Devraj; Ram Reddy

doi:10.18203/2349-2902.isj20223597

Authors

Madhusudhan Reddy Department of Urology and Renal transplantation, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
Arunkumar Annamalai Department of Urology and Renal transplantation, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
Irshad Ali Department of Urology and Renal transplantation, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
Dheeraj Soma Siva Sajja Department of Urology and Renal transplantation, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
Rahul Devraj Department of Urology and Renal transplantation, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
Ram Reddy Department of Urology and Renal transplantation, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2349-2902.isj20223597

Keywords:

Pediatric PCNL, Pediatric PCNL complication, Pediatric renal calculus, Pediatric stone outcomes

Abstract

Background: Children represent 2-4.3% of the total population of stone formers. Currently, the majority of stones in children can be managed either with shock-wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS), or a combination of these modalities. Open surgery is currently necessary in a few selected cases only. In our study, we wanted to evaluate the overall results of pediatric percutaneous nephrolithotomy (PCNL).

Methods: This study was based on patients of age <14 years who underwent PCNL at Nizam’s Institute of Medical Sciences, Hyderabad, India from January 2019 to December 2020. This was a retrospective study. Children with >1 cm calculi were included and the exclusion criteria were stones of <1 cm, deranged renal functions, and bleeding disorders.

Results: We performed 73 PCNL procedures on 65 children, achieved complete stone clearance in 93% and residual calculi (<10 mm) was seen following five cases; three patients underwent redo-PCNL. The complication rate in the present study was (16.4%) however, 100% of the total complications were minor i.e. Clavien score I and II, which were managed conservatively.

Conclusions: Thus, PCNL is a suitable treatment option for children with nephrolithiasis as avoiding open surgery in children. Higher rates of failure and numerous sessions under anesthesia with short wave lithotripsy (SWL) makes it a non-viable option in children. RIRS is not widely available, non-affordable by many and long-term outcomes not clearly known with respect to ureteral strictures in children.

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