Percutaneous nephrolithotomy for complete staghorn calculi in preschool children.
OBJECTIVE
To evaluate the safety and efficacy of percutaneous nephrolithotomy (PCNL) for the management of complete staghorn calculi in children <or=5 years old.


METHODS
The charts of 19 preschool children (15 boys, 4 girls) aged 20 months to 5 years (mean 4.2 years) with complete staghorn calculi who underwent PCNL at our center over a 3-year period were reviewed. The mean stone burden was 972 mm2 (range 870-1210 mm2). All procedures were performed with the patient in the prone position after retrograde catheterization with a 5F ureteral catheter. Fluoroscopyguided punctures were made by the urologist followed by track dilation to 24F. A 19F sheathless nephroscope passed through an Amplatz sheath was used in all cases. Flexible nephroscopy was used as an adjunct where necessary. Postoperative stone clearance was documented by plain film or, for radiolucent calculi, ultrasonography.


RESULTS
The majority of children (68%; N = 13) required two tracts, while five children (26%) required only one tract and one child required three. Complete clearance with PCNL monotherapy was achieved in 17 patients (89%), which increased to 94.7% with adjunctive shockwave lithotripsy. Stone analysis revealed struvite in 1, uric acid in 3, and calcium oxalate monohydrate in 15 patients.


CONCLUSIONS
In preschool children, PCNL for complete staghorn calculi is a safe and effective method for maximal stone clearance.
Aron
Monish
M
Department of Urology, All India Institute of Medical Sciences, New Delhi, India. monisharon@hotmail.com
Yadav
Rajiv
R
Goel
Rajiv
R
Hemal
Ashok K
AK
Gupta
Narmada P
NP
D002118:Calcium / Q000652:urine; D002129:Calcium Oxalate / Q000032:analysis; D002675:Child, Preschool; D019343:Citric Acid / Q000652:urine; D005260:Female; D006801:Humans; D007223:Infant; D007669:Kidney Calculi / Q000737:chemistry / Q000473:pathology / Q000601:surgery*; D008096:Lithotripsy; D017616:Magnesium Compounds / Q000032:analysis; D008297:Male; D009403:Nephrostomy, Percutaneous; D010710:Phosphates / Q000032:analysis; D012008:Recurrence; D000069877:Struvite; D014527:Uric Acid / Q000032:analysis / Q000652:urine
D017616:Magnesium Compounds; D010710:Phosphates; D002129:Calcium Oxalate; D014527:Uric Acid; D019343:Citric Acid; D000069877:Struvite; D002118:Calcium