Safety and efficacy of PCNL for the management of renal stones in children

Abstract

Background: The formation of stones is affected mainly by metabolic abnormalities, improper fluid intake, infection, some drugs, and urine pH. The purpose of this work was to assess the safety and efficiency of percutaneous nephrolithotomy (PCNL) for management of renal calculi in children. Methods: This prospective work was performed on 24 children, younger than 18 years, large renal stones larger than 2 cm) in its maximum diameter and lower calyceal stones of more than 1 cm and small renal stones (>2 cm) with failed extracorporeal shock wave lithotripsy (ESWL) or flexible ureteroscopy (F.URS). Results: The intraoperative complications included mild bleeding (12.5%) and calyceal perforation (16.7%). Low grade fever occurred in 3(12.5%) cases and high-grade fever occurred in one (4.2%) case. Mild hematuria occurred in 2(8.3%) cases and severe hematuria occurred in 1(4.2%). Colonic injury and urine leakage did not occur in any patient. 19(79.2%) patients were discharged after 2 days and only 5(20.8%) children after 3 days. One (4.2%) patient with residual (0.8cm) in renal pelvis, another (4.2%) patient with residual (1.2cm) in the upper calyx and a third (4.2%) patient with lower calyceal residual stone (1.3 cm). Conclusions: PCNL is a secure and efficient method for treating the large renal stones in youngsters. Tract dilation in children is a tailored technique that depends on stone burden, age of the patient, degree of hydronephrosis and availability of instruments. Miniaturization in children is important but optimization is more important.