Evaluation of the efficacy and safety of percutaneous nephrolithotomy in children

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.

References

Schwarz RD, Dwyer NT. Pediatric kidney stones: long-term outcomes. Urology. 2006;67:812-6.

Erdenetsesteg G, Manohar T, Singh H, Desai MR. Endourologic management of pediatric urolithiasis: proposed clinical guidelines. J Endourol. 2006;20(10):737-48.

Thomas K, Smith NC, Hegarty N, Glass JM. The Guy’s stone score- grading the complexity of percutaneous nephrolithotomy procedures. Urology. 2011;78(2):277-81.

Desai M. Endoscopic management of stones in children. Curr Opin Urol. 2015;15:107-12.

Sabnis RB, Chhabra JS, Ganpule AP, Abrol S, Desai MR. Current role of PCNL in pediatric urolithiasis. Curr Urol Rep. 2014;15(7):1-8.

Woodside JR, Stevens GF, Stark GL, Borden TA, Ball WS. Percutaneous stone removal in children. J Urol. 1985;134(6):1166-7.

Farahat WA, Kropp BP. Surgical treatment of pediatric urinary stones. AUA Updat Ser. 2007;26:21-8.

Sharma AP, Filler G. Epidemiology of pediatric urolithiasis. Indian J Urol. 2010;26:516-22.

Samad L, Aquil 5, Zaidi Z. Paediatric percutaneous nephrolithotomy: Setting new frontiers. BJU Int. 2006;97:359-63.

Nouralizadeh A, Basiri A, Javaherforooshzadeh A, Soltani MH, Tajali F. Experience of percutaneous nephrolithotomy using adult size instruments in children less than 5 years old. J Pediatr Urol. 2009;5:351-4.

Rosette JD, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R, et al. The clinical research office of the endourological society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5803 patients. J Endourol. 2011;25(1):11-7.

Sen H, Seckiner I, Bayrak O, Erturhan S, Demirbağ A. Treatment alternatives for urinary system stone disease in preschool aged children: results of 616 cases. J Pediatr Urol. 2015;11(34):1-5.

Dongol UMS, Limbu Y. Safety and efficiency of percutaneous nephrolithotomy in children. J Nepal Health Res Counc. 2017;15(36):130-4.

Mousavi-Bahar SH, Mehrabi S, Moslemi MK. Percutaneous nephrolithotomy complications in 671 consecutive patients: a single-center experience. Urol J. 2011;8:271-6.

Kukreja R, Desai M, Patel S, Bapat S, Desai M. Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol. 2004;18:715-22.

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Published

2022-12-30

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Original Research Articles