title: Paediatric anatrophic nephrolithotomy; stone clearance - at what price?
abstract: OBJECTIVE
  To evaluate the functional outcome of anatrophic nephrolithotomy in children.
  
  
  METHODS
  All children undergoing anatrophic nephrolithotomy for complex branching and multiple renal calculi over an 11-year period were studied prospectively. Demographic data, treatment details and outcome, as assessed by X-ray, ultrasonography and isotope studies, were recorded. Anatrophic nephrolithotomy was carried out with surface cooling of the kidney followed by nephrostomy drainage for 5-7 days.
  
  
  RESULTS
  Nine children (median age 4 years, range 7 months to 9 years) underwent anatrophic nephrolithotomy. Predisposing factors included urinary tract infection (by Proteus mirabilis) in all and hyper-calciuria in two children. The median (range) total ischaemic time at operation was 25 (15-40) min and the operative duration 150 (120-200) min. Three children required a blood transfusion. Stone clearance was incomplete in one child. There was no recurrent stone formation after a long-term follow-up (median 32 months, range 14-107) in the other patients. Isotope studies showed impaired split renal function (<40%) in six children before surgery; there was a significant decline (>5%) in divided function in five children (range 6-16%) after surgery.
  
  
  CONCLUSIONS
  Anatrophic nephrolithotomy is an effective means of rendering children with branching calculi stone-free, but this study suggests that it leads to some further parenchymal damage.
authors.affiliation: Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, UK.
authors.forename: D C
authors.initials: DC
authors.lastname: Gough
authors.forename: C T
authors.initials: CT
authors.lastname: Baillie
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007669:Kidney Calculi / Q000150:complications / Q000601:surgery*; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D011446:Prospective Studies; D011512:Proteus Infections / Q000150:complications; D011513:Proteus mirabilis; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000150:complications