Pediatric percutaneous nephrolithotomy: Assessing impact of technical innovations on safety and efficacy

Objectives: To assess the safety and efficacy of percutaneous nephrolithoto my (PCNL) in the pediatric age group and the impact of certain technical mo dification on the ultimate outcome. Patients and Methods: We studied 45 renal units in 40 patients under 15 yea rs of age who underwent PCNL at our institute. The average age was 9.2 year s (range 11 months-15 years). There were 5 bilateral, 11 multiple, and 9 st aghorn calculi, The average calculus size was 2.04 (0.9-4.5) cm, The PCNL w as done with an ultrasound-guided peripheral puncture, a planned staged app roach in some cases, and minimal tract dilatation with the use of a pediatr ic nephroscope and a specially designed slender probe for pneumatic intraco rporeal lithotripsy, Results: Complete stone clearance was achieved in 41 of the 45 renal units, giving an overall clearance rate of 91%, Minor pyrexia (<100 degrees F/<2 days) was seen in 10 patients, whereas serious pyrexia was seen in 5, One p atient had a prolonged leak from the nephrostomy site, which responded to d ouble-J stenting, and one patient had a pelvic perforation with hyponatremi a, which responded to conservative treatment. The average fall in hemoglobi n was 1.6 g/dL, but none of the patients required blood transfusion. Conclusion: We believe that our alterations in the standard technique of PC NL with the use of pediatric instruments can make it a safe and effective o ption in the modern management of pediatric urolithiasis.