title: Percutaneous nephrolithotomy for complex caliceal calculi and staghorn stones in children less than 5 years of age.
abstract: OBJECTIVE
  Treatment of children with staghorn and complex caliceal calculi is one of the most challenging problems in urology. We present our experience with percutaneous nephrolithotomy (PCNL) monotherapy for staghorn and complex caliceal calculi in children less than 5 years of age.
  
  
  METHODS
  Between 1991 and 2004, 27 boys and 9 girls aged 11 months to 4.5 years underwent PCNL for staghorn (33%) or complex caliceal (67%) calculi. The average bulk of the stones was 140.17 +/- 42.16 mm(2) (range 61-253 mm(2)). Staging of the procedure was preferred in children with renal insufficiency, urinary-tract infection, fragmentation time >60 minutes, or a stone burden requiring more than two tracts. Essential steps of the technique were a dynamic contrast study to select the appropriate-size Amplatz sheath and ultrasound guidance for renal access.
  
  
  RESULTS
  The average operative time was 72.11 +/- 28.86 minutes. The stone-free rate was 86%, the mean hemoglobin drop was 2.2 +/- 0.95 g/dL, and the mean hospital stay was 3.5 days. Less than half of the patients (42%) were treated in a single stage, the remainder requiring multiple procedures. Only 39% could be treated with a single tract. There was statistically significant increase in the blood loss in patients requiring multiple tracts (P = 0.008); however, staging the procedure did not increase the blood loss (P = 0.06).
  
  
  CONCLUSIONS
  Percutaneous nephrolithotomy is safe and effective in children less than 5 years of age. Staging the procedure, instrument modification, the timed "multi mini-perc" technique, and ultrasound-guided access help in achieving maximum stone clearance with minimal morbidity.
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
authors.forename: T
authors.initials: T
authors.lastname: Manohar
authors.forename: Arvind P
authors.initials: AP
authors.lastname: Ganpule
authors.forename: Prajay
authors.initials: P
authors.lastname: Shrivastav
authors.forename: Mahesh
authors.initials: M
authors.lastname: Desai
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000000981:diagnostic imaging / Q000601:surgery*; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011859:Radiography