title: Pediatric Percutaneous Nephrolithotomy-Experience of a Tertiary Care Center.
abstract: To present the experience of pediatric percutaneous nephrolithotomy (PCNL) of our center.
  
  
  
  This study was conducted from 1995 to 2015, on patients <15 years of age having renal and upper ureteral stones who underwent PCNL. Stones were classified as per Guy's stone score (GSS). Standard bull's eye technique was used for subcostal puncture. To avoid supracostal puncture, puncture was done in full inspiration or by oblique tract. If these maneuvers failed, then supracostal puncture was done. Tract was dilated to 24F.
  
  
  
  Six hundred sixty PCNLs were performed on 639 patients. Puncture was subcostal in 87.6% cases with tract dilated as much as 24F. Pelvicaliceal system was most commonly accessed through middle calix (73.94%). Upper caliceal puncture (23.78%) was more frequently used in complete (82.35%) and partial staghorn (51%) stones. Two tracts were made in 16 (2.42%) cases, because of large stone burden. Average operative time was significantly longer in complex (45.43 minutes) compared to simple stones (29.39 minutes). Overall success rate was 94.39%, but it was significantly lower in partial (91.37%) and complete staghorn stones (82.35%). Complications were present in 21.66% cases and were classified according to Clavien grading. Majority of patients (97.9%) had minor complications (Clavien grade 1 & 2). On multivariate analysis, GSS ≥2, stone size >200 mm2, and multiple caliceal, partial, and complete staghorn stones were predictors of failure and complications.
  
  
  
  PCNL is a minimally invasive surgical technique for removal of renal and upper ureteral stones, which have low morbidity rate, high success rate, and short hospital stay. Although the uses of smaller instruments are on the rise, procedure can still be safely performed in children using adult instruments. Supracostal approach if done cautiously does not increase morbidity rate.
authors.affiliation: SMS Medical College and Hospital , Jaipur, India .
authors.forename: Sher Singh
authors.initials: SS
authors.lastname: Yadav
authors.affiliation: SMS Medical College and Hospital , Jaipur, India .
authors.forename: Satinder Pal
authors.initials: SP
authors.lastname: Aggarwal
authors.affiliation: SMS Medical College and Hospital , Jaipur, India .
authors.forename: Rajeev
authors.initials: R
authors.lastname: Mathur
authors.affiliation: SMS Medical College and Hospital , Jaipur, India .
authors.forename: Krishan Kumar
authors.initials: KK
authors.lastname: Sharma
authors.affiliation: SMS Medical College and Hospital , Jaipur, India .
authors.forename: Ram Gopal
authors.initials: RG
authors.lastname: Yadav
authors.affiliation: SMS Medical College and Hospital , Jaipur, India .
authors.forename: Vinay
authors.initials: V
authors.lastname: Tomar
authors.affiliation: SMS Medical College and Hospital , Jaipur, India .
authors.forename: Ram Dayal
authors.initials: RD
authors.lastname: Teli
authors.affiliation: SMS Medical College and Hospital , Jaipur, India .
authors.forename: Deepak
authors.initials: D
authors.lastname: Jain
mesh_terms: D000293:Adolescent; D000818:Animals; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D015999:Multivariate Analysis; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D014514:Ureteral Calculi / Q000601:surgery*
keywords: Clavien score; Guy's stone score; pediatric renal calculi; percutaneous nephrolithotomy