title: Does previous open nephrolithotomy affect the outcomes and complications of percutaneous nephrolithotomy in children?
abstract: OBJECTIVE
  To analyze the success and complication rates of percutaneous nephrolithotomy (PCNL) performed in pediatric patients and to compare outcomes of the patients undergoing primary PCNL with those of patients who had undergone previous open nephrolithotomy.
  
  
  METHODS
  Between 2000 and 2011, PNL procedures were performed in 123 renal units (RU) of 111 children. We compared RU on which previous open surgery had been performed (group 1 RU = 26) on the same kidney with RU that had not been involved in previous surgery (group 2 RU = 97). Patient characteristics, pre- and postoperative hematocrit and creatinin levels, operative time, fluoroscopic screening time, stone free rate, complications and hospitalization time were documented and compared.
  
  
  RESULTS
  There were no significant differences between the groups in sex, stone burden, pre- and postoperative hematocrit levels. Mean age and pre- and postoperative creatinin levels were significantly higher in group 1 (p < 0.05). Mean operative time, fluoroscopic screening time and hospitalization times were similar in each group (p > 0.05). The stone free rates after PCNL were 65.4% in group 1 and 81.4% in group 2 (p > 0.05). Multiple access rate was higher in group 1; however, this was not statistically significant (27% vs. 15%, p > 0.05).
  
  
  CONCLUSIONS
  PCNL can be performed in pediatric patients who have previously undergone open nephrolithotomy but the success rates may be lower and risk of bowel injury higher. NCCT should be considered preoperatively for patients who have previously undergone open renal surgeries to investigate the presence of retrorenal colons. Our study includes relatively few patients with a history of open surgery and we believe that additional clinical studies with larger numbers of patients are needed to confirm our initial findings.
authors: University of Istanbul, Cerrahpasa School of Medicine, Department of Urology, Istanbul, Turkey. Electronic address: bulonal@yahoo.com.
authors: Bulent
authors: B
authors: Onal
authors: University of Istanbul, Cerrahpasa School of Medicine, Department of Urology, Istanbul, Turkey.
authors: Fetullah
authors: F
authors: Gevher
authors: University of Istanbul, Cerrahpasa School of Medicine, Department of Urology, Istanbul, Turkey.
authors: Burak
authors: B
authors: Argun
authors: University of Istanbul, Cerrahpasa School of Medicine, Department of Urology, Istanbul, Turkey.
authors: Cagatay
authors: C
authors: Dogan
authors: University of Istanbul, Cerrahpasa School of Medicine, Department of Urology, Istanbul, Turkey.
authors: Sinharib
authors: S
authors: Citgez
authors: University of Istanbul, Cerrahpasa School of Medicine, Department of Urology, Istanbul, Turkey.
authors: Ali Ulvi
authors: AU
authors: Onder
authors: University of Istanbul, Cerrahpasa School of Medicine, Department of Urology, Istanbul, Turkey.
authors: Ahmet
authors: A
authors: Erozenci
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007669:Kidney Calculi / Q000175:diagnosis / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects* / Q000379:methods; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Children; Kidney stone; Percutaneous nephrolithotomy