title: Percutaneous nephrolithotomy in the management of pediatric renal calculi.
abstract: OBJECTIVE
  In the era of extracorporeal shockwave lithotripsy (SWL), there are still some patients who will require percutaneous nephrolithotomy (PCNL). Our experience with this procedure is reviewed and discussed.
  
  
  METHODS
  Fifty five patients with a mean age of 7.9 years (10 months-14 years) underwent 67 PCNL procedures on 62 renal units between September 1997 and April 2001. Of the patients, 13 had previous open renal surgery, 4 had a solitary kidney, 4 were SWL failures, 2 had osteogenesis imperfecta, one had anuria secondary to bilateral calculi, 2 had poorly functioning kidneys, and 1 had cystinuria (complete staghorn calculus). One disabled patient with neurologic disorders who had multiple stones underwent PCNL in order to decrease the stone burden and to improve the kidney function. Operations were performed under the guidance of monoplane fluoroscopy. Pneumatic or ultrasonic lithotripsy and forceps extraction were used with a rigid nephroscope or ureteroscope (as an alternative instrument in small-caliber tracts).
  
  
  RESULTS
  Excluding the patient with neurologic disorders, 53 of the renal units (86.9%) were stone free at the time of discharge, and the success rate was 96.7%, with six patients having insignificant residual fragments after the procedure. In one patient, open surgery was required, and the other patient was sent for SWL treatment. There was no contiguous organ injury, but in 16 procedures (23.9%), intraoperative hemorrhage was seen, and blood transfusions were required.
  
  
  CONCLUSIONS
  Pediatric urolithiasis is usually a result of metabolic abnormalities and urinary tract infection, and there is always a risk of recurrence that may necessitate multiple additional intervention. Therefore, PCNL must be considered in selected cases by urologists who are experienced in adult percutaneous procedures.
authors.affiliation: Department of Urology, Cukurova University, Faculty of Medicine, Adana, Turkey. szeren@mail.cu.edu.tr
authors.forename: Sinan
authors.initials: S
authors.lastname: Zeren
authors.forename: Nihat
authors.initials: N
authors.lastname: Satar
authors.forename: Yildirim
authors.initials: Y
authors.lastname: Bayazit
authors.forename: Aysun Karabay
authors.initials: AK
authors.lastname: Bayazit
authors.forename: Kerem
authors.initials: K
authors.lastname: Payasli
authors.forename: Reha
authors.initials: R
authors.lastname: Ozkeçeli
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy; D008297:Male; D009403:Nephrostomy, Percutaneous; D012008:Recurrence; D016896:Treatment Outcome