Safety and efficacy of percutaneous nephrolithotomy in infants, preschool age, and older children with different sizes of instruments

Abstract

Objectives: To compare the morbidity and success rates among different age groups of children undergoing percutaneous nephrolithotomy (PCNL) using adult- or pediatric-sized devices. PCNL for renal stones in children may present problems because of small size, mobility of the pediatric kidney, and the small size of the collecting system.

Methods: Patients were categorized into 2 age groups: those < or =7 years old at the time of PCNL (group 1, n = 17 [38.6%]), and those 8-16 years old (group 2, n = 27 [61.4%]). Group 2 children were further divided into subgroups according to the use of pediatric- (group 2a, n = 12 [27.3%]) or adult-sized devices (group 2 b, n = 15 [34.1%]).

Results: Mean patient age was 4.1, 11.7, and 13.2 years in groups 1, 2a, and 2b, respectively. Fluoroscopy time, time to access the collecting system, operative time, and average postoperative hospital stay did not differ between the groups. However, hemoglobin decrease, bleeding during surgery, and blood transfusion rate was higher in group 2b. Stones were completely cleared in 82.4%, 83.3%, and 81.3% patients, and these percentages increased to 94.1%, 91.7%, and 93.7% with adjunctive shock wave lithotripsy and ureterorenoscopy in groups 1, 2a, and 2b, respectively.

Conclusions: Endourologic intervention in children usually requires instruments specific for preschool age; however, in older children with dilated collecting system, the use of adult instruments and techniques may achieve equal results.