Percutaneous nephrolithotomy in children: early and late anatomical and functional results.
OBJECTIVE
We report our experience with percutaneous nephrolithotomy (PCNL) in children, and evaluate its early and late anatomical and functional results.


METHODS
A total of 65 children with renal calculi were treated with PCNL. Patient age at operation ranged from 9 months to 16 years (mean +/- SD of 5.9 +/- 0.9 years), and 27 (41.5%) were younger than 5 years. Seven patients had bilateral renal stones and, therefore, the number of kidneys treated by PCNL was 72. The patients were followed regularly every 3 months during year 1 and every 6 months thereafter. Renal scans using technetium dimercapto-succinic acid for detection of renal scarring and technetium diethylenetetramine-pentaacetic acid for determination of selective glomerular filtration rate (GFR) were performed in all patients at least once during followup, which ranged from 6 to 72 months (mean +/- SD 40 +/- 10).


RESULTS
Early complications included significant intraoperative bleeding in 1 case, renal pelvis perforation in 1 and transient fever in 2. Mean hospital stay +/- SD was 3 +/- 1.2 days (range 2 to 21). Of the renal units 62 (86%) were stone-free after a single PCNL, and the remaining 10 with residual stones were treated with a second look PCNL (4) and shock wave lithotripsy (6). Stone-free rates at hospital discharge and at 3 months were 93% and 100%, respectively. During followup 6 patients (9%) had recurrence of small renal stones and were successfully treated with shock wave lithotripsy. None of the kidneys had scarring on dimercapto-succinic acid renal scan. All of the kidneys except 1 showed improvement or stabilization of the corresponding GFR determined by diethylenetetraminepentaacetic acid renal scan. Comparison of the mean preoperative GFR of the corresponding kidney (28.8 +/- 11.2 ml per minute) with mean value at followup (36.1 +/- 9.9) showed an increase of statistical significance (p <0.01).


CONCLUSIONS
PCNL is a safe and effective procedure for the treatment of children with renal calculi. At long-term followup the procedure improves renal function without renal scarring.
Dawaba
Mohamed S
MS
Urology & Nephrology Center, Mansoura University, Mansoura, Egypt.
Shokeir
Ahmed A
AA
Hafez
Ashraf  T
A
Shoma
Ahmed M
AM
El-Sherbiny
Mohamed T
MT
Mokhtar
Alaa
A
Eraky
Ibrahim
I
El-Kenawy
Mahmoud
M
El-Kappany
Hamdy A
HA
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007223:Infant; D007669:Kidney Calculi / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007902:Length of Stay; D008096:Lithotripsy; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects; D012008:Recurrence