title: Safety and efficacy of percutaneous nephrolithotomy for the treatment of paediatric urolithiasis.
abstract: BACKGROUND
  Paediatric percutaneous nephrolithotomy (PCNL) has revolutionised the treatment of paediatric nephrolithiasis. Paediatric PCNL has been performed using both adult and paediatric instruments. Stone clearance rates and complications vary according to the technique used and  surgeon experience. We present our experience with PCNL using adult instruments and a 28Fr access tract for large renal calculi in children under 18 years.
  
  
  METHODS
  All patients undergoing PCNL at our institution between 2000 and 2009 were reviewed. Demographics, surgical details and post-operative  follow-up information were obtained to identify stone clearance rates and complications.
  
  
  RESULTS
  PCNL was performed in 32 renal units in 31 patients (mean age: 10.8 years). The mean stone diameter was 19mm (range: 5-40mm). Twenty-six cases required single puncture and six required  multiple tracts. Overall, 11 staghorn stones, 10 multiple calyceal stones and 11 single stones were treated. Twenty-seven patients (84%) were completely stone free following initial PCNL. Two cases had extracorporeal shock wave lithotripsy for residual fragments, giving an overall stone free  rate of 91% following treatment. There was no significant bleeding or sepsis encountered either during the operation or in the post-operative setting. No patient required or received a blood transfusion.
  
  
  CONCLUSIONS
  Paediatric PCNL can be performed safely with minimal morbidity using  adult instruments for large stone burden, enabling rapid and complete stone clearance.
authors.affiliation: Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne NE7 7DN, UK. rajan.veeratterapillay@nuth.nhs.uk
authors.forename: R
authors.initials: R
authors.lastname: Veeratterapillay
authors.forename: M B K
authors.initials: MB
authors.lastname: Shaw
authors.forename: R
authors.initials: R
authors.lastname: Williams
authors.forename: P
authors.initials: P
authors.lastname: Haslam
authors.forename: A
authors.initials: A
authors.lastname: Lall
authors.forename: M
authors.initials: M
authors.lastname: De la Hunt
authors.forename: S T
authors.initials: ST
authors.lastname: Hasan
authors.forename: D J
authors.initials: DJ
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008096:Lithotripsy / Q000379:methods; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects* / Q000295:instrumentation; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D016896:Treatment Outcome