SAFETY AND EFFICACY OF PERCUTANEOUS NEPHROLITHOTOMY FOR THE TREATMENT OF PAEDIATRIC UROLITHIASIS: A SINGLE CENTER EXPERIENCE

Sarwar Noori Mahmood a


Department of Surgery, College of Medicine, University of Sulaimani. 

Submitted: 13/10/2018; Accepted: 15/1/2019; Published 21/3/2019
ABSTRACT


Background 

Children are more prone to the recurrent stone formation. To treat these cases, a procedure with a high success rate, less morbidity and the short convalescent period is needed. Percutaneous nephrolithotomy (PCNL) has become a well-established procedure for the management of renal calculi that are not amenable to (ESWL) in children of all age groups. 


Objectives 

We report our center experience and outcome of pediatric percutaneous nephrolithotomy (PCNL).


Patients and Methods

This prospective data analysis of 109 consecutive patients under the age of 17 who underwent PCNL from September 2009 to January 2016. All PCNL procedures were performed in prone position by a single experienced faculty urologist under general anesthesia and under fluoroscopic guidance. Rigid nephroscope was used. 


Results

One hundred and sixteen PCNLs were performed on 109 patients (six patient had bilateral PCNL), (65 boys and 44 girls), with a mean (range) age 6.57±4.51 (1-17) years, and mean (range) stone size was 2.341±1.105 (0.6-6) cm. Stones were complex staghorn stones in (16 cases), multiple stones in (51 cases) and single stones in (48 cases). Stones were present in complex anatomy included malrotated kidney (2 cases), previously treated pelviureteric junction obstruction (2 cases) and previously treated renal stones by open pyelolithotomy in 14 cases. Two tracts were made in six (5.1) cases, due to the large stone burden. Stone-free rate after PCNL monotherapy was 93%, which increased to 96.5% after shock wave lithotripsy, and it was significantly lower in complete staghorn stones (75 %). In the current study, 25 (21.72%) procedures were noted to had intraoperative/ postoperative complications and most of them (92%) were minor and all were managed conservatively.


Conclusion

PCNL in children is an effective and safe procedure for managing simple as well as complex renal calculi.



KEYWORDS

Percutaneous nephrolithotomy, Stone, Children, Complications.