Percutaneous nephrolithotomy for pediatric stone disease--our experience with adult-sized equipment.
OBJECTIVE
We evaluated the outcomes and complications of percutaneous nephrolithotomy (PNL) operations performed in pediatric patients using adult-sized surgical equipment at our center.


METHODS
The medical and surgical records of 23 children who underwent a total of 25 PNL operations using 24 or 26 F rigid nephroscopes were evaluated retrospectively. The following aspects were considered: stone burden; duration of surgery and complications; details concerning recovery, success, residual fragments and auxiliary procedures; and follow-up details.


RESULTS
The success rate of a single PNL session was 70.8%; with the use of auxiliary procedures this was increased to 91.6%. Perioperative and early postoperative complications were excessive bleeding and transfusion in two patients, hydro-pneumothorax in one, perforation of the collecting system in three and urinoma in one. Complications were more common in children aged <7 years or with staghorn stones. The mean time to catheter removal was 3.4 days and the mean hospitalization time was 4.8 days. Idiopathic hypercalciuria, hypocitraturia, cystinuria and hyperoxaluria were diagnosed in two, two, one and three patients, respectively.


CONCLUSIONS
Performing PNL with adult-sized equipment is associated with significant complications in children aged <7 years or with staghorn stones. This treatment should not be considered in routine clinical practice. As all stone-removal methods are associated with complications, PNL should be used only if other methods fail or are unavailable.
Gunes
Ali
A
Department of Urology, Medical Faculty, Inönü University, Malatya, Turkey. gunesali@yahoo.com
Yahya Ugras
Murat
M
Yilmaz
Ugur
U
Baydinc
Can
C
Soylu
Ahmet
A
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007669:Kidney Calculi / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation* / Q000379:methods*; D010147:Pain Measurement; D011183:Postoperative Complications; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013523:Surgical Equipment; D016896:Treatment Outcome; D014421:Turkey