Pediatric Percutaneous Nephrolithotomy: Assessing Impact of Technical Innovations on Safety and Efficacy

TLDR

The pediatric cohort had a mean age of 9.2 years, with 5 bilateral, 11 multiple, and 9 staghorn stones, and an average stone size of 2.04 cm. The study aimed to evaluate the safety and efficacy of percutaneous nephrolithotomy in children and to determine how technical modifications using pediatric instruments influence outcomes. PCNL was performed under ultrasound guidance with minimal tract dilation, employing a pediatric nephroscope and a slender pneumatic lithotripter, and a staged approach was used in selected cases across 45 renal units in 40 patients. Stone clearance was achieved in 41 of 45 units (91 %), with minor pyrexia in 10 patients, serious pyrexia in 5, one nephrostomy leak and one pelvic perforation that resolved conservatively, an average hemoglobin drop of 1.6 g/dL, and no transfusions required.

Abstract

To assess the safety and efficacy of percutaneous nephrolithotomy (PCNL) in the pediatric age group and the impact of certain technical modification on the ultimate outcome.We studied 45 renal units in 40 patients under 15 years of age who underwent PCNL at our institute. The average age was 9.2 years (range 11 months-15 years). There were 5 bilateral, 11 multiple, and 9 staghorn calculi. The average calculus size was 2.04 (0.9-4.5) cm. The PCNL was done with an ultrasound-guided peripheral puncture, a planned staged approach in some cases, and minimal tract dilatation with the use of a pediatric nephroscope and a specially designed slender probe for pneumatic intracorporeal lithotripsy.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 patient had a prolonged leak from the nephrostomy site, which responded to double-J stenting, and one patient had a pelvic perforation with hyponatremia, which responded to conservative treatment. The average fall in hemoglobin was 1.6 g/dL, but none of the patients required blood transfusion.We believe that our alterations in the standard technique of PCNL with the use of pediatric instruments can make it a safe and effective option in the modern management of pediatric urolithiasis.