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. 2010 Oct;26(4):549-54.
doi: 10.4103/0970-1591.74458.

Percutaneous nephrolithotomy for pediatric urolithiasis

Arvind P Ganpule  1 , Shashikant Mishra, Mahesh R Desai
Affiliations

Percutaneous nephrolithotomy for pediatric urolithiasis

Arvind P Ganpule et al. Indian J Urol. 2010 Oct.

Abstract

Pediatric urolithiasis is a management dilemma as a number of treatment options are available such as shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS). PCNL offers good clearance rates in a single hospital stay. The concerns with PCNL include the use of large instrument in pediatric kidneys, parenchymal damage and the associated effects on renal function, radiation exposure with fluoroscopy, and the risk of major complications including sepsis and bleeding. Evolution of pediatric PCNL technique such as miniaturization of instruments, limitation of tract size and advanced intracorporeal lithotripters have resulted in this technique being widely utilized for achieving stone-free status in appropriate patients. Many of the patients in our country come from remote areas thereby requiring special considerations during treatment. This also necessitates complete clearance in a single shorter hospital stay. PCNL appears to be the optimal option available in this scenario. The literature suggests that even complex and staghorn calculi can be tackled with this approach. The choice of the method to gain access is a matter of experience and personal preference. Ultrasound offers the advantage of visualization of spleen, liver and avoids injury. Miniaturization of instruments, particularly smaller nephroscopes and the potential to use lasers will decrease the morbidity and improve the clearance rates further. In this article, we analyze the management of pediatric urolithiasis with PCNL. We discuss our technique and analyze the results, complications and technique mentioned in the contemporary literature.

Keywords: Pediatric; percutaneous nephrolithotomy; urolithiasis.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
CT with 3D reconstruction volume rendering. Shows stone configuration in PA, Oblique and AP view
Figure 2
Figure 2
Miniperc nephroscope sheath in place (left), nephroscopy being performed (centre) and intracorporeal lithotripsy with Holmium laser lithotripsy (right)
See this image and copyright information in PMC

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