A critical appraisal of complications of percutaneous nephrolithotomy in paediatric patients using adult instruments

Predictive value of scoring systems for stone free status and complications before percutaneous nephrolithotomy in children

PCNL, a minimally invasive surgical technique for kidney stone removal, relies on achieving stone-free status, which various scoring systems aim to predict. This study assesses the predictive accuracy of the Clinical Research Office of the Endourological Society (CROES) and Guy's Stone Score (GSS) systems in determining stone-free rates following percutaneous nephrolithotomy (PCNL) in pediatric patients. A retrospective analysis was conducted on 580 pediatric patients who underwent PCNL at Çukurova University Urology Clinic between January 2007 and March 2024. Patients were categorized into two groups based on postoperative stone status: Group 1 and Group 2. CROES and GSS scores were calculated for each patient. The association between these scores and stone-free status, as well as postoperative complications, was statistically analyzed. Additionally, subgroup analyses were performed based on age groups. The study showed that 83.7% of patients achieved a stone-free condition postoperatively. Significant differences were found between the stone-free and residual stone groups regarding stone burden and operative time (p < 0.001). CROES had high accuracy for predicting stone-free outcomes (p < 0.001), while GSS was also effective in predicting both stone-free rates and complications. CROES was less effective in predicting complications. Both CROES and GSS are valuable for predicting PCNL outcomes in pediatric patients. While CROES is more reliable for stone-free rates, GSS better predicts complications. However, their limitations highlight the need for pediatric-specific scoring models. Until such models are developed, these systems should be used with caution alongside individualized clinical assessments.

Safety and efficacy of mini-percutaneous nephrolithotomy in management of renal stones in pediatric age group

BACKGROUND

Currently, kidney stones are frequently observed in children and teens.

OBJECTIVES

To evaluate the safety and efficacy of mini-percutaneous nephrolithotomy (MPCNL) in managing renal stones in pediatric patients.

PATIENTS AND METHODS

This retrospective case series study included 115 consecutive patients aged < 11 years old who underwent MPCNL at Sulaimani Teaching Hospital and Mercy Medical City, Sulaimaniyah, Iraq, from January 2016 to March 2021. MPCNL was done on all patients through 16-20 Fr tracts. The stone-free rate, perioperative complications, tract number, operative time, postoperative hemoglobin change, and hospitalization time were assessed.

RESULTS

The mean patients' age was 6.53 ± 1.3 years, and the mean stone burden was 2.073 ± 1.03 cm2. After a single session of MPCNL, 93.25% of patients attained a complete stone clearance through a single tract in 109 patients (94%) and two tracts in 6 patients (5.2%). Hospitalization time, operative time, postoperative hemoglobin drop, and perioperative complications were 2.23 ± 0.93 days, 39.26 ± 8.22 min, 0.51 ± 0.34 g/dL, and 25.21%, respectively. No major complications (Clavien grade III and IV) were found. Most complications were minor, including Clavien grade I (n = 18, 15.6%) and II (n = 11, 9.56%), which were managed conservatively.

CONCLUSIONS

MPCNL is an effective and potentially safe procedure for treating complex renal stones in pediatric patients aged < 11 years, yielding an excellent stone-free rate and acceptable complications.

Complications of Percutaneous Nephrolithotomy: Experience From a Tertiary Care Center

Introduction Renal stones are mineral concretions in the pelvicalyceal system. Their prevalence and recurrence are increasing globally. Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for the removal of kidney stones. It is a safer technique offering the highest stone-free rates. However, a few complications may still occur. We aimed to evaluate our experiences of PCNL and classify the complications as intraoperative, early postoperative, and late postoperative events. We also aimed to find the predictors of complications in PCNL. Methods A single-center prospective observational study was conducted from June 2021 to October 2022 where all patients who were >18 years old with radiopaque calculus in the kidney and underwent PCNL were included. Statistical analysis was performed using the IBM Statistical Package for Social Sciences (SPSS) software (IBM SPSS Statistics, Armonk, NY). A p-value of <0.05 was considered significant. Results Two hundred one patients including 137 males and 64 females participated in the study. The overall rate of complications was 21.9%. Most of the patients (16.4%) experienced minor complications of Clavien grades 1 and 2. A Clavien grade of >3 included major complications and was noted in 5.5% of patients. No mortality was seen in the postoperative period. Female patients (p = 0.028), a stone burden of >3 cm (p = 0.003), stones in multiple calyces (p = 0.001), hydronephrosis (p = 0.001), history of recently treated urinary tract infection (UTI) (p < 0.001), longer operative time (>91 minutes) (p < 0.001), Guy's stone scores (GSS) III and IV (p < 0.001), complex renal calculi (staghorn) (p = 0.002), and multiple punctures (p = 0.001) were associated with higher complication rates after PCNL. Conclusion Most PCNL-related complications are minor and resolve with conservative or minimally invasive management. However, there are certain complications that can limit the surgical outcome. The overall complication rate in the current study is similar to that reported in the literature. Bleeding was the most common intraoperative complication, whereas hematuria was the most common early postoperative complication. A stone burden of >3 cm, hydronephrosis, longer operative time, higher GSS, and multiple punctures can all affect the rate of complications.

Comparison of two percutaneous nephrolithotomy methods for the treatment of pediatric kidney stones: mini-percutaneous nephrolithotomy and standard percutaneous nephrolithotomy

OBJECTIVE

In this study, the aim was to compare the results of mini and standard percutaneous nephrolithotomy (PCNL) for the treatment of pediatric kidney stones.

MATERIALS AND METHODS

Data for 128 patients < 18 years of age who underwent mini and standard PCNL due to pediatric kidney stones were retrospectively examined. Patients were divided into two groups: mini-PCNL (16-20 Fr) and standard PCNL (26 Fr). Surgery time, number of punctures to the pelvicalyceal system, hospital stay, postoperative hemoglobin drop, complications and stone-free status (SFR) were compared between the groups. Additional surgical intervention (double-J stent, ureterorenoscopy, secondary PCNL) performed after the surgery was recorded. The absence of residual stones or < 3 mm residual stones on kidney, ureter and bladder radiography (KUB) and ultrasonography (USG) performed in the third postoperative month were accepted as success criteria.

RESULTS

There were 32 (43.8%) patients in the mini-PCNL group and 41 (56.2%) patients in the standard PCNL group. The mean age was 9.3 ± 4.1 years in the mini-PCNL group and 10.1 ± 5.4 years in the standard PCNL group. Mean stone size in the mini-PCNL group was 2.1 ± 1.2; while for standard PCNL it was 2.3 ± 1.4. The mean surgery time was statistically significantly higher in the mini-PCNL group (p = 0.005). There was no difference between the groups in terms of intraoperative double J stent use, postoperative complications and SFR. A double J stent was inserted in two patients in the mini-PCNL group and in one patient in the standard PCNL group due to urine leakage from the nephrostomy tract in the postoperative period. Although the postoperative hemoglobin drop was found to be significantly higher in standard PCNL (p = 0.001), hematuria and blood transfusion rates were low in both groups. Mean hospital stay was shorter in the mini-PCNL group compared to standard PCNL (3.6 ± 1.2 days vs. 2.5 ± 1.1; p = 0.018).

CONCLUSIONS

Although mini-PCNL has longer surgery time compared to standard PCNL, it should be preferred for the treatment of pediatric kidney stones due to advantages such as similar success and complication rates to standard PCNL, short hospital stay and less postoperative hemoglobin drop.

Endoscopic combined intrarenal surgery composed of micro-perc and retrograde intrarenal surgery in the treatment of complex kidney stones in children

OBJECTIVE

This research aims to explore the efficiency and safety of endoscopic combined intrarenal surgery (Micro-ECIRS) composed of micro-percutaneous nephrolithotomy (Micro-perc) and retrograde intrarenal surgery (RIRS) in the Galdakao-modified supine Valdivia (GMSV) position for a single session for the treatment of complex nephrolithiasis in children.

MATERIALS AND METHODS

This study retrospectively reviewed patients aged < 18 years who underwent Micro-ECIRS in the GMSV position for renal stones larger than 2 cm under ultrasound guidance between August 2020 to May 2022 at our institution.

RESULTS

A total of 13 patients (8 males and 5 females) received Micro-ECIRS for renal stones under ultrasound guidancewhile adopting the GMSV position. The average stone size was 2.7 cm (range: 2.1-3.7 cm). Among them, 6 patients had left kidney stones, 5 patients had right kidney stones, and 2 patients had bilateral kidney stones. The mean operative time was 70.5 min (range: 54-93 min). The mean hospital stay was 6.4 days (range: 4-9 days). The mean hemoglobin decrease was 8.2 g/L (range: 5.1-12.4 g/L). The total number of kidneys that had complete stone clearance was 8 kidneys at 48 h postoperatively, 11 kidneys at 2 weeks postoperatively, and 14 kidneys at 1 month postoperatively.

CONCLUSION

Our results demonstrate that Micro-ECIRS while patients are in the GMSV position is a safe and effective method for the treatment of complex children nephrolithiasis. However, all children made three hospital visits and received anesthesia three times. Further research is needed to confirm these findings.

Current status of nomograms and scoring systems in paediatric endourology: A systematic review of literature

INTRODUCTION

The incidence of paediatric kidney stone disease is increasing worldwide, with the requirement for endourological interventions mirroring this. Multiple nomograms, grading tools and scoring systems now exist in the adult setting, which aim to enhance the pre-operative planning and decision-making associated with these surgeries. In recent years, there has been increasing interest in nomograms dedicated for use in the paediatric setting. This study provides an up-to-date review and assessment of available paediatric endourology nomograms and scoring systems.

METHODS

A comprehensive search of worldwide literature was conducted according PRISMA methodology. Studies describing paediatric-specific endourology nomograms, scoring systems or grading tools and studies externally validating these tools, or existing adult tools in a paediatric population, were evaluated and included in the narrative data synthesis.

RESULTS

A total of 7 endourology nomograms were identified. 4 were paediatric-specific, 2 for shockwave lithotripsy, 1 for percutaneous nephrolithotomy or ureteroscopy and 1 for percutaneous nephrolithotomy specifically. Only the 2 shockwave lithotripsy nomograms have been externally validated in 4 further studies and showed efficacy in predicting treatment success. 3 adult tools, all specific to PCNL have been investigated and validated in a paediatric setting in 11 studies. In general, they showed efficacy in the prediction of stone free rate but were poor at predicting likelihood of complications.

CONCLUSION

A limited number of paediatric-specific endourology predictive nomograms are available to aid in the management of kidney stone disease, with the strongest evidence supporting those designed for shockwave lithotripsy. Although 3 adult tools have been implemented, there are problems applying these to the paediatric setting and further development of paediatric-specific tools is necessary.

A systematic review of nomograms used in urolithiasis practice to predict clinical outcomes in paediatric patients

INTRODUCTION

Nomograms, used to predict the risk and success of treatment of urinary tract stones, are being used in paediatric clinical practice. However, no studies have determined the best prediction model. This study aimed to identify the most robust nomogram(s) for predicting clinically relevant outcomes in urinary stone disease in paediatric patients.

METHODS

The EMBASE, MEDLINE, Cochrane Systematic Reviews, and Cochrane Central Register of Controlled Trials via Ovid were searched for publications on May 13, 2021. No study design and publication year limitations were applied. The risk of bias in the included studies was determined using PROBAST.

RESULTS

The review included fourteen studies, involving 3888 paediatric patients. We identified seven prognostic stone nomograms (Dogan, Onal, CMUN, SKS, Guy's stone score, S.T.O.N.E and CROES) that were validated for use in paediatric patients. Both Dogan and Onal scores were developed and internally and externally validated in different studies with similar AUC scores between 0.6 and 0.7. For PCNL practice, two nomograms were developed and internally validated (CMUN, SKS) but not externally validated. The Guy's stone score was found to have the lowest overall accuracy in predicting stone-free rates in the externally validated nomograms studies. Nine of the fourteen studies included were judged as having a high risk of bias in their overall judgement.

CONCLUSION

The systematic review findings should be interpreted with caution given the heterogeneity of included studies. There is no difference between the use of the Dogan or Onal score for predicting outcomes associated with ESWL. For predicting outcomes of PCNL, CROES had the greatest supportive evidence, whilst the SKS or CMUN scores lack external validation and require further evaluation to assess their utility in predicting PCNL outcomes.

Outcomes of Mini-Percutaneous Nephrolithotomy in Children and Adolescents: A 10-Year Single-Centre Experience From Kuwait

The current study retrospectively reviewed data for all children and adolescents who underwent mini-percutaneous nephrolithotomy (PCNL) at Ibn Sina Hospital and Sabah Al Ahmad Urology Centre in Kuwait over 10 years. Accordingly, the 40 patients underwent mini-PCNL. Among them, 21 patients (52.5%) had varying degrees of hydronephrosis, with mild to moderate severity accounting for nearly half of them, whereas six (15%) had multiple stones. The median operative time was 54.5 (43.3-64) minutes. Moreover, 11 patients needed flexible ureteroscopy (URS) and double-J (DJ) ureteric stent, and one patient required DJ ureteric stent only. None of the cases developed intraoperative bleeding. The median hospital stay of the included patients was three (2.3-4) days. Residual stone was observed in 11 patients (27.5%), with a median size of 3 (2 to 7) mm. The incidence of postoperative complications was 27.5% (n = 11 patients), with three patients experiencing postoperative bleeding (7.5%) and eight patients developing a fever (20%). All patients had mild postoperative pain. However, no leakage, sepsis, or pelvic injury occurred. None of the patients required revision. In conclusion, mini-PCNL was a safe and effective procedure in children and adolescents with renal stones.

Comparison of Mini-Percutaneous Nephrolithotomy by Standard and Miniperc Instruments in Pediatric Population: A Single-Center Experience

Objective:

The objective of this study was to compare mini-percutaneous nephrolithotomy (PCNL) performed by standard and Miniperc techniques in pediatric patients.

Materials and Methods:

This was a retrospective study conducted at our institution between January 2012 and December 2017. The outcomes of pediatric renal stones treated by mini-PCNL done by Miniperc and standard techniques were compared in terms of the drop in the hemoglobin, stone-free rate, and analgesic requirement in the first 24 h.

Results:

A total of 57 children (age: 1–16 years), who underwent mini-PCNL by Miniperc equipment (n = 23) and standard equipment (n = 34), were included in this study. The postoperative mean drop in hemoglobin was significantly higher in mini-PCNL done by standard compared to the Miniperc technique. The stone-free rate was 95.65% in the Miniperc group and 94.12% in the standard mini-PCNL group. The need for analgesics was significantly lower in the Miniperc group compared to the standard mini-PCNL group (P = 0.0002). In the Miniperc group, the majority of the patients required only one dose of analgesics, whereas, in the standard mini-PCNL group, around 44% of the patients required three or more than three doses of analgesics to reduce postoperative pain.

Conclusion:

Both the techniques were safe and efficacious in the management of pediatric renal stone and stone clearance. However, the Miniperc technique resulted in significantly less pain and a lower dosage of analgesics.

THE FUNCTIONAL STATE OF THE RENAL PARENCHYMA AFTER VARIOUS VIDEO ENDOSURGICAL METHODS OF TREATMENT OF PATIENTS WITH LARGE AND COMPLEX KIDNEY STONES

The work is based on the analysis of literature data devoted to the problem of preserving the functional state of the kidneys with various video endoscopic methods of surgical treatment of large and complex kidney stones. The purpose of the review is to highlight the likelihood of deterioration in the functional state of the kidneys in the postoperative period. A detailed analysis of postoperative outcomes in various minimally invasive methods of treatment of patients with large and complex kidney stones was carried out, with an overview of the possibility of using dynamic nephroscintigraphy as a method of objectively assessing the functional state of the kidneys.

The Efficacy of Guy's Stone Score for Predicting the Stone-Free and Complication Rates in Children Treated by Percutaneous Nephrolithotomy

Introduction: To determine the efficacy of Guy's stone score (GSS) for predicting stone-free and complication rates after percutaneous nephrolithotomy (PCNL) in children. Patients and Methods: A total of 197 renal units (RUs) in 173 children (≤17 years) who referred to our clinic were included in our study. RUs with stones were classified as four groups according to GSS. The results were designated as stone free or as having residual stones. Complications were evaluated according to GSS, the Satava, and modified Clavien grading system. All parameters were evaluated by using univariate and multivariate analysis. Results: The median age of patients was 6 years (1-17 years). Stone-free status was 77% and complication rate was 17%. Stone-free rate was established 89% for group 1, 78% for group 2, 75% for group 3, and 57% for group 4. There was a positive association between GSS and stone-free status (p = 0.02). No relationship was found between GSS and the complication rate (p = 0.42). In multivariate analysis, GSS was the only independent factor for predicting stone-free status. Conclusion: Current study revealed that GSS has a predictive ability for stone-free status; however, GSS is insufficient for predicting complications after pediatric PCNL. Even though, GSS does not fully reflect the characteristics of the pediatric population, we believe that it might provide useful insights for clinicians when recommending and discussing treatment options for children with urolithiasis.

Which factors affect the success of pediatric PCNL? Single center experience over 20 years

OBJECTIVE

We aimed to investigate the impact of surgeons' experience on pediatric percutaneous nephrolithotomy (PCNL) outcomes.

MATERIALS AND METHODS

Between June 1997 and June 2018, 573 pediatric patients with 654 renal units underwent PCNL for renal stone disease by senior surgeons. Data were divided into two groups, group-1 (n = 267), first ten years period, group-2 (n = 387); second ten years period.

RESULTS

Mean ± SD age of patients was 7.6 ± 4.9 (1-17) years. The stone-free rates (SFR) assessed after 4 weeks were 74.9% vs. 83.4% in group-1 vs. group-2, respectively (p = 0.03). The mean operation time, fluoroscopy time, and the number of patients requiring blood transfusion significantly decreased in group 2 (100.4 ± 57.5 vs. 63.63 ± 36.3, 12.1 ± 8.3 vs. 8.3 ± 5.4, and 24.3% vs. 2.9%; p < 0.001, p < 0.001, and p = 0.002 in group-1 versus group-2, respectively). On multivariate analysis, increasing stone size increased operation time (p < 0.001), fluoroscopy time (p < 0.001), intraoperative and postoperative blood transfusion rates (p = 0.006 and p = 0.018, respectively), and hospital stay (p = 0.002) but was not associated with change of glomerular filtration rate (GFR) (p = 0.71). Sheath size also correlated with increased fluoroscopy time (p < 0.001), operation time (p < 0.001), intraoperative blood transfusion (p < 0.001) and hospital stay, but sheath size did not affect postoperative blood transfusion (p = 0.614) or GFR change (p = 0.994).

CONCLUSIONS

The percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure and is well accepted because of its lower complication rate and high efficiency for pediatric patients. Stone and sheath size are predictive factors for blood loss and hospital stay. During 20 years, our fluoroscopy time, operation time, blood loss, and complication rates decreased, and stone-free rate increased.

Critical Application of Adult Nephrolithometric Scoring Systems to Children Undergoing Mini-Percutaneous Nephrolithotomy

Objective: To evaluate and compare the ability of the Guy's stone score (GSS), the S.T.O.N.E. nephrolithometry, and the Clinical Research Office of the Endourology Society (CROES) nomogram to predict the outcome of mini-percutaneous nephrolithotomy (MPNL) in children, and to identify which of the predictors involved in these scoring systems can separately affect this outcome. Patients and Methods: All children younger than 14 years who had MPNL in our center over a period of 3 years were included prospectively. Bivariate analyses were done to evaluate the associations of the three scoring systems and the predictors composing them with single-session stone clearance and complications. Receiver operating characteristic (ROC) curve analyses of the three scoring systems were conducted to evaluate and compare their abilities to predict the outcomes. Decision curve analyses for the three scoring systems were conducted to evaluate the clinical benefit of using each of them to predict stone clearance. Results: We consecutively enrolled 92 renal units in 89 children with a median age of 9.5 years. Single-session stone clearance was achieved in 76 (82.6%) renal units. Complications occurred with 19 (20.7%) procedures. Stone multiplicity (p = 0.043), staghorn stone (p = 0.007), prior stone treatment (p < 0.001), number of calices involved (p = 0.006), stone burden (p = 0.003), GSS (p < 0.001), S.T.O.N.E. nephrolithometry (p = 0.012), and CROES nomogram (p < 0.001) had significant associations with stone clearance. Only stone attenuation was significantly associated with complications (p = 0.031). For prediction of stone clearance, CROES nomogram demonstrated the greatest area under the ROC curve and the greatest net benefit on decision curve analyses. Conclusions: For children undergoing MPNL, CROES nomogram is the best to predict stone clearance. However, none of the studied scoring systems predicted complications efficiently.

Efficacy and Safety of Supracostal Access for Mini Percutaneous Nephrolithotomy in Pediatric Patients

OBJECTIVE

To evaluate the efficacy and safety of supracostal percutaneous nephrolithotomy (PCNL) through the 11th intercostal space and compare it with subcostal PCNL in children with renal calculi.

MATERIALS AND METHODS

Children with renal calculi who underwent PCNL between January 2010 and December 2017 were divided into 2 groups: supracostal PCNL (group 1) and subcostal PCNL (group 2). Stone location, stone burden, location of the access points, operative time, postoperative visual pain score, success rate, hospital stay, and complications according to the modified Clavien classification were compared. Comparison of medians was done using Mann Whitney U test and the means were compared using t test.

RESULTS

Group 1 had 50 patients while group 2 had 60 patients. The stone-free rate was 84.0% and 85.0% in groups 1 and 2, respectively after 1 session of PCNL (P = .885). After auxiliary procedures, it increased to 96.0% and 96.6%, respectively (P = .852). The mean fall in hematocrit was 0.9% in group 1 and 1.5% in group 2 (P = .11) whereas the median pain score was 4 in group 1 and 3 in group 2 (P = .37). In all, 54 complications were recorded the commonest among which were grade I (81.5%). Twenty-nine complications were observed in group 1 while 25 complications were observed in group 2 (P = .088). One patient developed nephropleural fistula while another patient developed hydropneumothorax. Both belonged to group 1.

CONCLUSION

Supracostal access for PCNL is an effective and safe alternative to subcostal access for children with renal calculi in terms of stone-free rate and complications.

Technique, complications, and outcomes of pediatric urolithiasis management at a tertiary care hospital: evolving paradigms over the last 15 years

BACKGROUND

Despite technological advancements, there is lack of consensus for the standard treatment modalities for pediatric urolithiasis.

OBJECTIVE

The primary objective was to review the management of pediatric urolithiasis over the last 15 years in terms of technical modifications, surgical outcomes, and complications. The secondary objective was to compare the efficacy and outcomes of standard percutaneous nephrolithotomy (PCNL) and mini-PCNL for renal and upper ureteric calculi.

STUDY DESIGN

Medical records of all patients aged <18 years who presented to the authors' tertiary care hospital in northern India between August 2003 and December 2018 were reviewed retrospectively. Before 2010, all PCNLs performed were standard PCNL, whereas after 2010, most PCNLs performed were mini-PCNL. Thus, the patients were divided into two groups: group A (patients up to 2010) and group B (patients after 2010). These were compared for the type of treatment, success rate, and complications. The outcomes of surgical management of lower ureteric and vesical calculi were also reviewed.

RESULTS

During this period, there were 580 children with urolithiasis (677 stone sites). There were 265 patients (321 stone sites) in group A and 315 patients (356 stone sites) in group B. The median age was seven years (range: 3-18 years). The most common location of calculus was the collecting system of the kidney (n = 398, 58.8%). A total of 175 stone sites (25.8%) were located in the ureter. Urinary bladder calculi were seen in 43 (6.4%) patients. Multiple stones were seen in 61 sites (9.0%). A total of 115 patients in group A underwent standard PCNL, whereas in group B, nine patients underwent standard PCNL and 129 underwent mini-PCNL. Group B had a significantly higher stone clearance rate for mini-PCNL (P < 0.001). Minor complications (grades 1 and 2) accounted for a majority of overall complications in both groups (87.5% in group A and 94.9% in group B).

DISCUSSION

Mini-PCNL is an excellent option for renal calculi in children as it offers dual advantages of improved stone clearance and reduced major complications such as bleeding. Ureteroscopic lithotripsy has been established as the standard for small lower ureteric calculi.

CONCLUSION

For renal and upper ureteric calculi, mini-PCNL has evolved as standard technique with a high stone-free rate and minimum complications compared with standard PCNL. Extracorporeal shockwave lithotripsy and ureteroscopic lithotripsy (URSL)/retrograde intrarenal surgery are acceptable alternatives for smaller stone burden. For lower ureteric and vesical calculi, retrograde approaches such as cystolithotripsy and URSL have now become the standard of care.

Mini- versus standard percutaneous nephrolithotomy for treatment of pediatric renal stones: is smaller enough?

INTRODUCTION

Miniaturized percutaneous nephrolithotomy (PCNL) has gained increased popularity owing to efforts in recent years to lower peri-operative morbidity while maintaining a high stone-free rate (SFR).

OBJECTIVE

The outcomes of pediatric renal stones treated by mini-PCNL (MPCNL) versus standard PCNL (SPCNL) were retrospectively assessed.

STUDY DESIGN

A retrospective data analysis of 134 consecutive patients younger than 17 years who underwent PCNL between January 2014 and July 2018 was performed. The patients were categorized into two treatment groups depending on the tract size and instruments used. Seventy-five patients were treated by SPCNL using adult instruments via a 22-26 Fr tract, and 59 patients were treated by MPCNL using pediatric instruments via a 16-20 Fr tract.

RESULTS

A total of 134 children (SPCNL = 75; MPCNL = 59) underwent PCNL and subsequent evaluation. Patient demographics and stone characteristics were comparable between the two groups. The mean stone size ranged from 1.9 ± 1.162 cm in the MPCNL group to 2.2 ± 1.424 cm in the SPCNL group, and the overall SFR was 89.5% in the MPCNL group and 94.7% in the SPCNL group. When comparing the common characteristics, no significant difference was found between the two surgical access regarding the mean operative duration, SFR, incidence of peri-operative complications, and the rate of bleeding requiring a blood transfusion. Conversely, the mean postoperative hemoglobin decrease was significantly lower in the MPCNL group relative to the SPCNL group, at 0.354 ± 0.299 g versus 0.568 ± 0.332 g, respectively (P = 0.001). In addition, the mean duration of hospitalization was significantly lower in the MPCNL group than in the SPCNL group, at 1.91 ± 1.154 days compared with 2.41 ± 1.14 days, respectively (P = 0.014).

DISCUSSION

Herein, the authors report the first systematic review of the first center in the locality treating this cross section of patients. This review reveals that the use of these smaller instruments can deliver a strong safety profile while achieving good stone clearance. As an alternative to decreasing the peri-operative morbidity associated with SPCNL, MPCNL can be conveniently used without affecting the outcomes of the procedure. It is a safe and feasible procedure for maximal clearance of stones and should comprise the treatment of choice-regardless of age-for experienced endourologists.

CONCLUSION

MPCNL represents a valuable way of treating simple and complex renal stones in children, with an operative time, SFR, and overall complication rate comparable with those of SPCNL. Mini-PCNL resulted in shorter hospitalization and fewer hemoglobin drops.

Percutaneous Nephrolithotomy in Children: Analysis of Nationwide Hospitalizations and Short-Term Outcomes for the United States, 2001-2014

OBJECTIVE

To describe population-wide utilization rates and outcomes of percutaneous nephrolithotomy (PCNL) in the management of pediatric upper urinary tract calculi (UUTC).

PATIENTS AND METHODS

Patients <18 years with a diagnosis of UUTC, who underwent PCNL between 2001 and 2014 were identified from the National Inpatient Sample database. Annual PCNL rates, based on the at-risk population for each year, were estimated, and change in utilization rate was analyzed using negative binomial regression. Perioperative outcomes, hospital length of stay (LOS), and costs were determined; continuous and categorical variables were analyzed using nonparametric tests and Chi-squared tests, respectively. Trends tests and multivariable analyses (MVAs) were also performed where appropriate.

RESULTS

An estimated 3206 pediatric PCNL procedures were performed. Mean annual PCNL rate increased significantly relative to 2001 (incidence rate ratio = 1.40; 95% confidence interval 1.15-1.71, p = 0.001). Proportion of PCNL as a fraction of all inpatient surgical procedures for UUTC also significantly increased over time, from 15.7% in 2001 to 26.4% in 2014 (p < 0.0001). Complications overall occurred in 20.7% of cases, with a significantly rising rate over time period (p < 0.0001). Complication rates were similar across hospital types and geographic regions. Median hospitalization cost was significantly higher for the West than for each of the other regions (p < 0.05 in each case). Median LOS was also highest for the West (4 days vs 3 days for each of the other regions). In MVA, significant predictors of both increased LOS and costs included black race, comorbidities of hypertension, diabetes, coagulopathy and neurologic disease, hospitalization in the South, and presence of complications. Race, gender, comorbidities, and treatment year were among the predictors of complications.

CONCLUSIONS

PCNL utilization in the management of pediatric UUTC has significantly increased since 2001, with an associated increase in complication rates, although major complications were uncommon. Regional variations in costs and LOS were evident.

Comparison of Guy's Stone Score and clinical research of the endourological society nomogram for predicting surgical outcomes after pediatric percutaneous nephrolithotomy: a single center study

BACKGROUND

The aim of this study was to compare the efficacy of Guy's Stone Score (GSS) and Clinical Research of the Endourological Society (CROES) Nomogram in predicting PCNL outcomes in the pediatric patients with kidney stone.

METHODS

A retrospective review of the clinical data of 120 pediatric patients who underwent PCNL between August 2004 and February 2016 was performed. Patients were grouped according to stone-free (SF) status and complication status. The patients whose history, preoperative physical examination records, biochemical analysis, imaging records were available and who did not neglect the follow-up, were included in the study. The stone size measurement and the scoring system calculation were always performed by the same surgeon. Multivariate logistic regression analysis were performed to identify the factors associated with SF status and complication status.

RESULTS

CROES score was significantly higher in SF patients compared to the patients with residual stones (P=0.009), while stone burden and GSS were significantly lower (P=0.023 and P=0.025). Median hospitalization day of patients with complications was significantly higher compared to the patients without complication (P=0.005). To have stones located in multiple calyces was the only statistically significant condition when two groups were compared (P=0.014). In multivariate analysis, CROES score was the independent factor associated with SF status (OR:0.984 95% CI: 0.959-1.010 P=0.017) and to have stones located in multiple calyces was the independent factor associated with complication status (OR:0.265 95% CI:0.087-0.808 P=0.02).

CONCLUSIONS

CROES nomogram is associated with the SFR while GSS is not. Both scoring systems do not have predictive accuracy on complication status. Further studies are required to make modifications in the scoring systems in the pediatric population.

A new simple scoring system for prediction of success and complication rates in pediatric percutaneous nephrolithotomy: stone-kidney size score

INTRODUCTION

Nomograms and scoring systems designed for predicting the success of percutaneous nephrolithotomy (PCNL) in adults are currently available. However, no scoring system currently exists primarily for predicting PCNL success in children.

OBJECTIVES

The objective of this study was to develop a scoring system to predict the stone-free and complication rates by using pre-operative parameters.

STUDY DESIGN

A retrospective analysis was conducted on data from 434 renal units belonging to patients with kidney stones who underwent PCNL between 1997 and 2017. Renal stone index was calculated by dividing the length of the stone along its longest axis by the length of the kidney along its longest axis. Guy's Stone scores, S.T.O.N.E scores, and CROES scores for adults were calculated by filling in the variables for each patient. Factors that predicted success and complications were examined by univariate and multivariate analyses.

RESULTS

Mean age was 8.3 (1-16) years, and male to female ratio was 236:165. When stone-free patients were compared with other patients, there was a statistically significant difference in the average stone/kidney index (SKI) value (stone size/kidney size on longitudinal axis) (0.266 vs 0.339, P < 0.001). In multivariate analysis, factors that predicted success were the SKI and number of stones. A newly developed scoring scale, the stone-kidney score (SKS), combined scores for both the SKI and the number of stones into one value. A minimum total SKS score was 2, and a maximum total SKS score was 4. Success rates for SKS scores of 2, 3, and 4 were 86.4%, 73%, and 62.9% (P < 0.001), respectively. Complication rates for SKS scores of 2, 3, and 4 were 13%, 22.1%, and 23.8%, respectively.

DISCUSSION

The new scoring system has only two variables (number of stones and SKI) and three risk groups. An SKS score is easier to use and calculate. An SKI value can be simply calculated on any imaging modality by dividing the length of the stone along its longest axis by the length of the kidney along its longest axis. As in the new scoring system, the SKI value combined with the number of stones is useful in predicting stone-free rates after PCNL.

CONCLUSION

When evaluated together, the SKI and presence of multiple stones may predict stone-free rates pre-operatively. The SKS is an individual-specific method that can be easily used in pediatric clinical practice. Further studies are required to develop and standardize this method.

Predictive ability of Guy's stone score in pediatric patients undergoing percutaneous nephrolithotomy

BACKGROUND

Several authors have evaluated, in a number of external validation and predominantly adult studies, Guy's stone score (GSS) as a predictive tool for the assessment of stone clearance after percutaneous nephrolithotomy (PCNL). However, there are limited and conflicting data investigating whether GSS could be a potential independent factor associated with residual stone rates and complications of PCNL for children.

OBJECTIVE

The aim of the current study was to evaluate the ability of GSS, as an independent factor, to predict residual stone rates and complications in pediatric patients undergoing PCNL.

STUDY DESIGN

The records of the pediatric patients who had undergone PCNL for stone disease at the current department were retrospectively reviewed. Variables included patient, stone, and treatment parameters. The GSS was used for assessment of stone complexity. Univariate and multivariate analyses were performed to evaluate factors associated with residual stone rates and complications of pediatric PCNL.

RESULTS

The study group consisted of 114 children (63 boys and 51 girls) with a median (interquartile range) age of 6 (3-11) years and who had undergone 122 PCNLs (eight bilateral). Multivariate logistic regression analysis (Summary Table) demonstrated that the independent risk factors for increased residual stone rate following pediatric PCNL monotherapy were GSS (OR 3.14, 95% CI 1.31-7.49, P = 0.01) and number of calyces involved (OR 4.02, 95% CI 1.11-14.53, P = 0.033). Multivariate logistic regression analysis demonstrated that the independent risk factors for complications following pediatric PCNL were surgical experience (OR 2.72, 95% CI 1.09-6.82, P = 0.032), and operation time (OR 1.01, 95% CI 1.00-1.03, P = 0.040).

DISCUSSION

A prediction model is needed to pre-operatively counsel patients and evaluate outcomes for measuring treatment success of PCNL. The GSS provides a simple, reliable and reproducible tool for describing the complexity of PCNL while predicting postoperative stone-free status, despite its limitations. However, little research has been conducted on the applicability of GSS in pediatric patients undergoing PCNL. In addition, conflicting results have been reported about its association with complications of pediatric PCNL.

CONCLUSIONS

The current study found that although GSS had a significant predictive ability for residual stone rates after pediatric PCNL revealed by multivariate logistic regression, the results did not conclude that complexity of GSS was directly proportional to complications of pediatric PCNL. The factors, including calyceal involvement and surgeon experience, may need to be incorporated in GSS to further improve its ability to predict outcomes of pediatric PCNL.

IRB APPROVED PROTOCOL NUMBER

1422.

Factors predicting postoperative febrile urinary tract infection following percutaneous nephrolithotomy in prepubertal children

BACKGROUND

Predictive tables and scoring systems can predict stone clearance. However, there is a paucity of evidence regarding the prediction of complications during percutaneous nephrolithotomy (PCNL), particularly in children, which remains under-researched. To our knowledge, no studies have evaluated the risk factors for febrile urinary tract infection (FUTI) after pediatric PCNL.

OBJECTIVES

To assess the predictive factors of FUTI in prepubertal children after PCNL and determine whether any prophylactic cephalosporins are superior for decreasing the FUTI rate.

STUDY DESIGN

Data from 1157 children who underwent PCNL between 1991 and 2012 were retrieved from the multicenter database of the Turkish Pediatric Urology Society. Children >12 years of age were excluded, leaving 830 children (364 girls, 466 boys). Data were analyzed according to the presence of FUTI and compared between the FUTI and non-FUTI groups.

RESULTS

Mean age was 6.46 ± 3.38 years. Twenty-nine (3.5%) children had FUTI which was confirmed by urine culture. FUTI occurred more frequently in young children (5.5%) than school-age children (2.4%). In univariate analysis, there were significant differences between the FUTI and non-FUTI groups regarding age, cephalosporin subgroup (first, second and third generation cephalosporin), side of PCNL, staghorn stones, tract size, operative time, postoperative ureteral catheter usage, perioperative complications (SATAVA), and blood transfusion. Multivariate analysis revealed that age, side of PCNL, staghorn stones, tract size, operative time, and blood transfusion were independent predictors of FUTI.

DISCUSSION

The smaller tract size could cause FUTI with poor fluid drainage that may lead to elevate renal pelvic pressure and trigger bacteremia-causing pyelovenous backflow. Filling the calyx and renal pelvis by a staghorn stone and the resulting obstruction of fluid drainage may elevate intrarenal pelvis pressure. Longer operative time is likely to increase renal pelvic pressure over longer periods, which may account for FUTI after pediatric PCNL.

CONCLUSIONS

Younger age, right-sided PCNL, staghorn stones, mini-PCNL, longer operative time, and blood transfusion are risk factors for FUTI. First-, second-, and third-generation cephalosporins are equally effective for prophylaxis in prepubertal children undergoing PCNL.

Outcomes of second-look percutaneous nephrolithotomy in renal calculi-a single centre experience

OBJECTIVE

Percutaneous nephrolithotomy (PCNL) carries significant potential for morbidity. Scant data exists on indications and outcomes of second-look PCNL after a failure to completely clear renal stones at the first attempt. We present our experience with second-look PCNL.

MATERIAL AND METHODS

This was a retrospective record review of 922 patients who underwent unilateral PCNL at a tertiary care center in South India. Baseline patient, stone characteristics and outcomes were compared between 844 patients undergoing primary PCNL and 78 patients requiring second-look PCNL.

RESULTS

Increased stone complexity in terms of Guy stone score (GSS), stone size, staghorn calculi and stones in multiple locations were significantly associated with primary treatment failure (p<0.001). Operative time >75 min had a significant association with need for second-look PCNL and complications. Initial PCNL was discontinued due to bleeding (28; 35.9%), pelvicalyceal system perforation (3; 3.9%) and purulent urine leading to urosepsis and hemodynamic instability (2; 2.6%). Staged PCNL was done in 44 (56.3%) patients. During second-look PCNL, new access tracts were necessary in majority (42; 53.9%) of the patients and multiple tracts in 20 (25.6%) patients. In second-look PCNL, complications were comparable to primary PCNL (p=0.289).

CONCLUSION

Second-look PCNL should be advocated in patients where the initial PCNL was discontinued due to bleeding, perforation of collecting system, prolonged operative time (>75 min) and in patients with large stone burden.

Fluoroscopy-free ultrasonography-guided percutaneous nephrolithotomy in pediatric patients: a single-center experience

OBJECTIVES

To present the safety and efficacy of fluoroscopy-free ultrasound-guided PCNL for the treatment of renal calculi in pediatric patients of all ages.

METHODS

30 children with mean age of 5 years (6 months-12 years) underwent totally ultrasound-guided PCNL from March 2013 to August 2016. The pyelocalyceal system was punctured in prone position using only ultrasonography guidance, and the tract was dilated using a single shot dilation technique. No fluoroscopy was used during any of the stages of renal access. The procedure was performed using adult-sized instruments.

RESULTS

The mean stone size was 27.1 ± 8.7 mm. Mean access time was 4.3 ± 2 min. Mean nephroscopic time was 34.6 ± 15.2 min. Mean hospital stay of patients was 3 days (range 2-5). 21 patients were stone-free after the procedure (70% success rate). Only four patients out of 30 experienced postoperative complications.

CONCLUSIONS

The results of this study showed that fluoroscopic-free ultrasound-guided PCNL in pediatric patients of all ages is safe, highly efficient, and minimizes potential radiation exposure risks associated with the procedure.

Complications after prone PCNL in pediatric, adult and geriatric patients - a single center experience over 7 years

Introduction

CROES-Clavien system (CCS) for grading complications in percutaneous nephrolithotomy (PCNL) is a step towards standardization of outcomes. We categorized complications based on CCS and predicted risk factors across the entire cohort and individually for pediatric (P: ≤18 years), adult (A: 19-65 years) and geriatric (G: ≥65 years) subgroups to assess the risk factors in each subset. We assessed association of complications with length of hospitalization (LOH) and operation time (OT).

Materials and Methods

Retrospective record review of unilateral PCNL performed between January 2009-September 2015 at a tertiary care center in India, performing around 150 PCNL per year.

Results

Out of 922 (P=61; A=794; G=67) PCNL, 259 (28.09%) complications occurred with CCS I, II, III and IV constituting 152 (16.49%), 72 (7.81%), 31 (3.36%) and 4 (0.43%) respectively and its distribution was similar across the subsets and majority (224; 24.3%) were minor (CCS-1, 2). Placement of a nephrostomy (47.4%; 18/38) in Group P, supracostal access, ≥2 punctures, higher GSS, nephrostomy, staghorn stones, ≥2 stones, stone size in Group A and hydronephrosis and prolonged OT in Group G were significantly associated with complications. On logistic regression, need of nephrostomy (adj. OR - 4.549), OT (adj. OR - 1.364) and supracostal access (adj. OR - 1.471) significantly contributed to complications in the study population. LOH was found to be significantly associated with complications (p<0.001).

Conclusions

Contrary to the belief that extremes of ages are associated with complications of prone PCNL, we found age does not alter the incidence or grade of complications and LOH.

Prediction of Pediatric Percutaneous Nephrolithotomy Outcomes Using Contemporary Scoring Systems

PURPOSE

We evaluate the applicability of contemporary percutaneous nephrolithotomy scoring systems in pediatric patients and compare their predictive power regarding postoperative outcomes.

MATERIALS AND METHODS

We retrospectively analyzed the records of 125 children who were diagnosed with renal calculi and underwent percutaneous nephrolithotomy between March 2011 and April 2016. Predictive scores, which consisted of Guy's Stone Score, S.T.O.N.E. (stone size, tract length, obstruction, number of involved calyces and essence/stone density) nephrolithometry and CROES (Clinical Research Office of the Endourological Society) nomogram, were calculated for all patients included in the study. Patient demographics, stone-free rate and complications were all analyzed and are reported.

RESULTS

Median Guy's Stone Score was 2 (IQR 2 to 3) in patients with residual stones (group 1) and 2 (1 to 2) in those who were stone-free (group 2). Median respective CROES nomogram scores were 215 (IQR 210 to 235) and 257 (240 to 264), and S.T.O.N.E. nephrolithometry scores were 8 (7 to 9) and 5 (5 to 6, all p <0.0001). S.T.O.N.E. score demonstrated the greatest accuracy in predicting stone-free rate. Guy's Stone Score was significantly correlated with complications but the CROES and S.T.O.N.E. scores were not significantly correlated with complications.

CONCLUSIONS

The scoring systems analyzed could be used to predict success of percutaneous nephrolithotomy in the pediatric setting. However, further studies are needed to formulate modifications for use in children. The main variables in the scoring systems, ie stone burden, tract length and case volume, were measured using records from adult patients. Besides these variables, the relatively small pelvicalyceal system and higher incidence of anatomical malformations in children could potentially affect percutaneous nephrolithotomy outcomes.

Percutaneous endoscopic treatment for urinary stones in pediatric patients: where we are now

BACKGROUND

Percutaneous nephrolithotomy (PCNL) has been adopted for pyelo-calyceal stones treatment in pediatric patients, starting from the 90's. Very recently, miniaturization of endoscopic instruments allowed less invasive procedures with low complication rate. We reviewed our experience on upper tract stone treatment utilizing two different percutaneous accesses, focusing on the recent new miniaturized devices offered for pediatric renal stones.

METHODS

Patients presenting upper tract urinary stones observed from January 2011 to December 2015 and treated by percutaneous renal access were prospectively evaluated: age, sex, metabolic issues, associated abnormalities, treatment modalities, hospital stay and complication rate were recorded in a specific database. Two different endourological percutaneous modalities were adopted, depending to the stone size and position. PCNL was performed through a direct calyceal puncture under ultrasonographic and fluoroscopic guidance and Amplatz access dilatation till 24 Fr. Ballistic energy was used for fragmentation. Micropercutaneous (Microperc) procedure was recently offered utilizing a 4.85 Fr metallic needle and Holmium:YAG laser lithotripsy under direct vision through a 0.9 mm high resolution optic flexible wire connected with a telescope.

RESULTS

Thirty-eight percutaneous access to pyelo-calyceal renal stones were performed on a total of 108 children treated for upper tract stones, aged 4 to 18 years (mean age 7.5 years). The overall number of procedures was 144 (36 repeated procedures). Cystinuria was diagnosed in 5 patients. PCNL was adopted in 28 patients, Microperc was utilized in 8 patients. Hemoglobin dropdown was limited to 1.20±0.80 mg% in PCNL and was not significant in Microperc. No blood transfusion was needed. No significant complications were observed. Stone free rate or minimal not significant residuals were achieved in 82% of PCNL and in 87.5% of Microperc, after a single procedure.

CONCLUSIONS

Percutaneous endoscopic treatment of renal calculi is feasible in pediatric age, with high success rate in a single step. Advanced miniaturized endoscopic devices as Microperc guarantee high efficacy and reduced complication rate, but endo-urological experience and adequate learning curve are required, especially in small body weight children. Centralization of these patients in Pediatric Stone Centers is welcomed to optimize results and reduce risks.

Do Outcomes of Percutaneous Nephrolithotomy in Horseshoe Kidney in Children Differ from Adults? A Single-Center Experience

OBJECTIVE

To compare the efficacy, outcome, and safety of percutaneous nephrolithotomy (PCNL) for stones in horseshoe kidney (HSK) in children compared with adults.

METHODS

We retrospectively reviewed data of 18 renal units in children (<15 years) and 26 renal units in adult patients with HSKs who underwent PCNL between March 2008 and June 2015.

RESULTS

Mean age of the study group was 25.92 ± 15.79 with adults having 36.12 ± 11.84 (range 20-65) and children having 10.32 ± 2.88 (range 5-15). Mean stone burden was 311.20 ± 203.99 (104-1080 mm(2)) with children of 211.13 ± 130.21 (104-500 mm(2)) and adults of 382.68 ± 219.27 (114-1080 mm(2)). Success rate is defined as either complete stone free or with asymptomatic and clinical insignificant residuals fragment of <3 mm on postoperative imaging. Initial success rate was 79.54% (86.61% in adults vs 72.22% in children). After auxiliary procedure, the final success rate is 93.18% (adults: 92.30% vs children: 94.44%). Overall complications noted in 12 cases with 23.07% in adults and 33.33% in children, most of them were minor complications.

DISCUSSION

There was no significant difference in initial and final success rate. Complication is slightly higher in children although statistically not significant. The outcomes and complications are similar to those reported in other studies of pediatric PCNL.

CONCLUSIONS

Outcomes in child and adult HSKs do not differ significantly with respect to success rate and complications. Children have a relatively smaller stone burden compared with adults with a similar distribution. We found that most of the puncture can be made infracostal in children as well as adults.

Multicenter External Validation and Comparison of Stone Scoring Systems in Predicting Outcomes After Percutaneous Nephrolithotomy

BACKGROUND AND PURPOSE

Several scoring systems have recently emerged to predict stone-free rate (SFR) and complications after percutaneous nephrolithotomy (PCNL). We aimed to compare the most commonly used scoring systems (Guy's stone score, S.T.O.N.E. nephrolithometry, and CROES nomogram), assess their predictive accuracy for SFR and other postoperative variables, and develop a risk group stratification based on these scoring systems.

MATERIALS AND METHODS

We performed a retrospective review of patients who have had a PCNL at four academic institutions between 2006 and 2013. Primary outcome was SFR within 3 weeks of the surgery and secondary outcomes were operative time (OT), complications, and length of stay (LOS). We performed chi-squared, t-test, logistic, linear, and Poisson regressions, as well as receiver operating characteristics curve with area under the curve (AUC) calculation.

RESULTS

We identified 586 patients eligible for analysis. Of these, 67.4% were stone free. Guy's, S.T.O.N.E., and CROES score were predictive of SFR on multivariable logistic regression (odds ratio [OR]: 1.398, 95% confidence interval [CI]: 1.056, 1.852, p = 0.019; OR: 1.417, 85% CI: 1.231, 1.631, p < 0.001; OR: 0.993, 95% CI: 0.988, 0.998, p = 0.004) and have similar predictive accuracy with AUCs of 0.629, 0.671, and 0.646, respectively. On multivariable linear regression, only S.T.O.N.E. was an independent predictor of longer OT (β = 14.556, 95% CI: 12.453, 16.660, p < 0.001). None of the scores were independent predictors of postoperative complications or a longer LOS. Poisson regression allowed for risk group stratification and showed the S.T.O.N.E. score and CROES nomogram to have the most distinct risk groups.

CONCLUSIONS

The three evaluated scoring systems have similar predictive accuracy of SFR. S.T.O.N.E. has additional value in predicting OT. Risk group stratification can be used for patient counseling. Further research is needed to identify whether or not any is superior to the others with regard to clinical usefulness and predictive accuracy.

STPEDISET: A novel innovation for percutaneous nephrolithotomy in children

PURPOSE

The aim of this study was to report the outcomes of PCNL in patients in whom the Short and Thin Pediatric Set (ST PEDISET) had been used.

METHODS

Data from 21 patients (11 boys and 10 girls) who underwent PCNL for renal stones using the ST PEDISET between April 2013 and February 2015 were analyzed retrospectively. The patients were evaluated by plane radiography and USG after surgery.

RESULTS

In total 21 children (11 boys and 10 girls) with a median age of 13months (range 5months to 4years) who underwent PCNL were included in the study. The median stone burden was 16mm (range 10-36mm). The success rate was 85.7%. Sixteen patients (76.2%) were stone free and two patients (9.5%) had clinically insignificant residual fragments (CIRF). The median length of hospital stay was 4days (range 2-9days).

CONCLUSIONS

The data of this study clearly show that the ST PEDISET is safe, effective and ergonomic for percutaneous nephrolithotomy in preschool-age children. This study indicates the need for randomized trials on larger cohorts to confirm these findings, and thus improve the surgical procedure.

Our Experience with Totally Ultrasonography-Guided Percutaneous Nephrolithotomy in Children

Purpose: To present the safety and efficacy of totally ultrasonography-guided percutaneous nephrolithotomy (PCNL) for managing urinary stones in pediatric patients. Patients and Methods: Ten children with a mean age of 5.4 (3-11) years underwent totally ultrasonography-guided PCNL from March 2013 to November 2013. The pyelocaliceal system was punctured with the patient in the prone position by using ultrasonographic guidance, and the tract was dilated using a single-shot dilation technique. All steps of renal access were performed by using ultrasonography; no fluoroscopy was used. PCNL in all cases was performed by using adult instruments. Results: The mean stone size was 28.9±6.7 mm (range 17-35 mm). The mean access time to stone was 4.45±2.25 minutes (range 3-10 min). The mean nephroscopic time was 45.9±17 minutes (range 20-80 min). The stone-free rate was 83%. Mean hospital stay of patients was 3 days (range 2-5 days). No major complications were happened. Only one patient needed ureteral stent insertion because of urinary leakage from the nephrostomy tract. Conclusion: Our experience with totally ultrasonography-guided PCNL using adult size instruments in children revealed proper results and acceptable complications compared with the standard technique of PCNL. Likewise, this alternative method has the advantage of preventing radiation hazard.

Percutaneous nephrolithotomy and ureteroscopy in children: evolutions

The increasing incidence of pediatric stone disease has coincided with significant advances in technology and equipment, resulting in drastic improvements in management. Miniaturization of both ureteroscopes and percutaneous nephrolithotomy (PCNL) equipment has facilitated access to the entirety of the urinary tract and has made ureteroscopy a first-line therapy option along with shock-wave lithotripsy for kidney and ureteral stones. Advances in PCNL have decreased patient morbidity while preserving stone clearance rates. In this review, the advances in operative approach for ureteroscopy and PCNL in children and its applicability to current surgical management of pediatric stone disease are discussed.