H. Badawy et al., Percutaneous management of renal calculi: Experience with percutaneous nephrolithotomy in 60 children, J UROL, 162(5), 1999, pp. 1710-1713
Purpose: We report our experience with percutaneous nephrolithotomy in a pe
diatric population in which primary as well as recurrent stone episodes are
frequent and the need for less invasive procedures is imperative.
Materials and Methods: Percutaneous nephrolithotomy was performed in 60 chi
ldren 3 to 13 years old (average age 6), including 44 boys (73.3%) and 16 g
irls (26.7%). There was a single obstructing renal calculus in 43 patients,
while 17 had multiple calculi. The procedure was performed in 1 stage in 4
9 patients, and it was staged with preliminary nephrostomy in 11 who presen
ted with calculous anuria and elevated serum creatinine. Normal saline was
used as an irrigant and perioperatively serum electrolytes were measured to
monitor fluid absorption in 18 patients. Stones were extracted intact from
40 patients (66.6%) and ultrasonic lithotripsy was performed in 20 (33.3%)
.
Results:Of the 60 patients 50 (83.3%) were rendered stone-free at I session
. Incomplete stone clearance at I session was due to intraoperative bleedin
g requiring blood transfusion, extravasation, multiple stones that were ina
ccessible via 1 tract, displacement of stone fragments into an inaccessible
calix and insignificant residual fragments less than 3 mm. in 2 cases each
. During followup of 3 months to 6 years (average I year) no late complicat
ions were noted.
Conclusions: Percutaneous nephrolithotomy is a safe and relatively efficaci
ous mode of managing pediatric renal calculi. Although higher success rates
are achieved in adults, caution should be exercised in children, in whom d
iligent attempts at stone clearance in 1 session may be made at the expense
of safety.