THE ROLE OF PERCUTANEOUS NEPHROLITHOTOMY IN THE MANAGEMENT OF PEDIATRIC RENAL CALCULI

Purpose: Minimally invasive techniques for the treatment of urinary ca lculi in children are recommended due to an increased probability of r ecurrence. Percutaneous nephrolithotomy is well established in adults but to our knowledge this procedure has not been reported previously i n a large series of children. We review our experience with percutaneo us nephrolithotomy in children, Materials and Methods: From 1987 to 19 95 percutaneous nephrolithotomy was performed in 25 children 3 to 16 y ears old (median age 8). Indications for percutaneous nephrolithotomy were an obstructed kidney in 10 cases, large stone size or staghorn ca lculus in 8, failed extracorporeal shock wave lithotripsy in 4 and res idual stones after open surgery in 3, There were 15 solitary renal, 4 staghorn and 2 upper ureteral stones, and 5 children had multiple rena l calculi.Results: Percutaneous nephrolithotomy was performed once in 22 patients, and 2, 3 or 5 times in the remainder, Of the 25 patients 17 (68%) were stone-free at hospital discharge or shortly thereafter f ollowing a single session of percutaneous nephrolithotomy. Retained ca lculi after a single percutaneous nephrolithotomy treatment were much more common with staghorn stones (2 of 4 cases or 50%) and multiple st ones (3 of 5 or 60%) compared to solitary renal stones (2 of 15 or 13. 3%). With subsequent extracorporeal shock wave lithotripsy or repeat p ercutaneous nephrolithotomy the stone clearance rate was as high as 92 %. At a 2 to 66-month followup (average 23) no late complications were noted. Radioisotope scans available in 10 cases before and after perc utaneous nephrolithotomy revealed unchanged differential function and evidence of significant renal scars in only 1. Conclusions: Percutaneo us nephrolithotomy is a suitable and safe procedure for treating renal stones in children.