Paediatric percutaneous nephrolithotomy, a retrospective review

Abstract

    Introduction: Paediatric percutaneous                         nephrolithotomy (PCNL) has recently emerged as the treatment modality of choice for children with large renal stones. The complication and stone free rates have improved with expertise and miniaturization of                   instruments. In this study, we review our experience with paediatric PCNL with respect to clinical                     presentation, details of surgery, complications,                  associated metabolic abnormalities and outcomes.  Materials and Methodology :  This was a                     retrospective study from 2014-2017 that included all children (<15 years of age) undergoing PCNL. The age, symptoms at presentation, renal function, stone burden (using the Guy’s stone score) were listed. Details of the operative procedure including number of punctures, tract size, duration of the procedure, blood loss,             transfusion rate, clearance and complications (using the CROES Clavien-Dindo score) were studied. The Guy’s stone score was correlated with blood loss and                complications. Stone analysis and the results of               metabolic evaluation of the patients were also recorded. Results : There were a total of twelve children (nine boys and three girls). The mean age was 7.8 years (SD 3.9). The most common presenting complaints were abdominal pain, gross haematuria, urinary infection and renal failure. Four patients had chronic kidney disease. Two patients had undergone prior operations (Open pyeloplasty-1, open pyelolithotomy-1). Lower posterior calyceal puncture was used in all except one patient who required an additional middle calyceal puncture. The tract size ranged from 26-28 F and adult               instruments were used. The mean duration of operation was 137 minutes (SD 35.5) and the primary stone                clearance rate was 58.3%. One patient required blood transfusion. Two patients had self-limiting fever and one was treated for urinary sepsis. Higher grades of                   complications were found with increasing complexity of the stone as per Guy’s score. However, there was no                  statistically significant correlation between Guy’s score, blood loss and incidence of complications. The most             common stone types were uric acid and struvite. Seven children were found to have metabolic abnormalities which included oxaluria, calciuria and uricosuria. Conclusions : Paediatric PCNL using adult instruments is a safe and    effective procedure for large renal calculi. A higher Guy’s score may be associated with higher grade of                      post-operative complication. Metabolic evaluation and      management is vital due to the high incidence of associated abnormalities predisposing to stone disease in children.