Limits...
Percutaneous nephrolithotomy in children: A preliminary report.

Elderwy AA, Gadelmoula M, Elgammal MA, Osama E, Al-Hazmi H, Hammouda H, Osman E, Abdullah MA, Neel KF - Urol Ann (2014)

Bottom Line: Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients.Auxiliary procedures were successful for the remaining 4 patients (nephroscopic clearance in one and shockwave lithotripsy in 3).Tubeless PNL is a better choice for children.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Division of Pediatric Urology, Assiut University Hospitals, Assiut, Egypt.

ABSTRACT

Objectives: The recurrence of pediatric nephrolithiasis, the morbidity of repeated open surgical treatment as well as our experience in percutaneous nephrolithotomy (PNL) in adult patients, all derived us to shift to PNL for managing renal stones >1.5 cm in pediatric patients. Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients.

Materials and methods: During the period of the month between May 2011 and April 2013, 38 children (47 renal units) underwent PNL for renal stones 1.5-5 cm in length. Patient demographics, stone characteristics, and clinical outcome were prospectively studied. Data of those who underwent conventional and tubeless PNL were compared. Median follow-up period was 12 months (range: 6-24).

Results: The median age at presentation was 8-year (range: 3-12). The operative time ranged from 30 to 120 min (median 90). Overall stone clearance rate was 91.5% after single PNL. The median hospital stay was 3 days. Auxiliary procedures were successful for the remaining 4 patients (nephroscopic clearance in one and shockwave lithotripsy in 3). Tubeless PNL was performed in 17 renal units with a comparable outcome to conventional ones. The perioperative complications were noted in 5/47 (10.6%) of all procedures (Clavien Grade II in 4 and Clavien Grade IIIa in 1) and were managed conservatively.

Conclusions: Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible if performed by a well-experienced endourologist. Tubeless PNL is a better choice for children.

No MeSH data available.


Related in: MedlinePlus

Non-contrast computerized tomography (a and b) and matrix calculi specimen after percutaneous nephrolithotomy (PNL) (c) of a 3-year-old girl with recurrent bilateral stagging renal stones 3.8 cm on the right side and 4.5 cm on the left. She underwent successful eventless asynchronous bilateral tubeless PNL (1 month apart). Stone culture showed proteus mirabilis infection. The patient received prophylactive trimethoprim/sulfamethoxazole at dose of 2/10 mg/kg at bedtime for 3 months. No recurrence was noticed after 18 months of follow-up
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4127852&req=5

Figure 1: Non-contrast computerized tomography (a and b) and matrix calculi specimen after percutaneous nephrolithotomy (PNL) (c) of a 3-year-old girl with recurrent bilateral stagging renal stones 3.8 cm on the right side and 4.5 cm on the left. She underwent successful eventless asynchronous bilateral tubeless PNL (1 month apart). Stone culture showed proteus mirabilis infection. The patient received prophylactive trimethoprim/sulfamethoxazole at dose of 2/10 mg/kg at bedtime for 3 months. No recurrence was noticed after 18 months of follow-up

Mentions: As regards the stone clearance; 43 units were clear after the first session PNL. Nephroscopic clearance under GA through the same access tract was performed for one patient 2 days postoperatively. Single session SWL under GA was performed for 3 patients with unreachable fragments after 3-4 weeks in the presence of double-J stent. Accordingly, our initial stone-free rate (SFR) was 91.5% and cumulative SFR after auxiliary procedures was 100% at 3 months follow-up visit [Figures 1 and 2].


Percutaneous nephrolithotomy in children: A preliminary report.

Elderwy AA, Gadelmoula M, Elgammal MA, Osama E, Al-Hazmi H, Hammouda H, Osman E, Abdullah MA, Neel KF - Urol Ann (2014)

Non-contrast computerized tomography (a and b) and matrix calculi specimen after percutaneous nephrolithotomy (PNL) (c) of a 3-year-old girl with recurrent bilateral stagging renal stones 3.8 cm on the right side and 4.5 cm on the left. She underwent successful eventless asynchronous bilateral tubeless PNL (1 month apart). Stone culture showed proteus mirabilis infection. The patient received prophylactive trimethoprim/sulfamethoxazole at dose of 2/10 mg/kg at bedtime for 3 months. No recurrence was noticed after 18 months of follow-up
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4127852&req=5

Figure 1: Non-contrast computerized tomography (a and b) and matrix calculi specimen after percutaneous nephrolithotomy (PNL) (c) of a 3-year-old girl with recurrent bilateral stagging renal stones 3.8 cm on the right side and 4.5 cm on the left. She underwent successful eventless asynchronous bilateral tubeless PNL (1 month apart). Stone culture showed proteus mirabilis infection. The patient received prophylactive trimethoprim/sulfamethoxazole at dose of 2/10 mg/kg at bedtime for 3 months. No recurrence was noticed after 18 months of follow-up
Mentions: As regards the stone clearance; 43 units were clear after the first session PNL. Nephroscopic clearance under GA through the same access tract was performed for one patient 2 days postoperatively. Single session SWL under GA was performed for 3 patients with unreachable fragments after 3-4 weeks in the presence of double-J stent. Accordingly, our initial stone-free rate (SFR) was 91.5% and cumulative SFR after auxiliary procedures was 100% at 3 months follow-up visit [Figures 1 and 2].

Bottom Line: Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients.Auxiliary procedures were successful for the remaining 4 patients (nephroscopic clearance in one and shockwave lithotripsy in 3).Tubeless PNL is a better choice for children.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Division of Pediatric Urology, Assiut University Hospitals, Assiut, Egypt.

ABSTRACT

Objectives: The recurrence of pediatric nephrolithiasis, the morbidity of repeated open surgical treatment as well as our experience in percutaneous nephrolithotomy (PNL) in adult patients, all derived us to shift to PNL for managing renal stones >1.5 cm in pediatric patients. Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients.

Materials and methods: During the period of the month between May 2011 and April 2013, 38 children (47 renal units) underwent PNL for renal stones 1.5-5 cm in length. Patient demographics, stone characteristics, and clinical outcome were prospectively studied. Data of those who underwent conventional and tubeless PNL were compared. Median follow-up period was 12 months (range: 6-24).

Results: The median age at presentation was 8-year (range: 3-12). The operative time ranged from 30 to 120 min (median 90). Overall stone clearance rate was 91.5% after single PNL. The median hospital stay was 3 days. Auxiliary procedures were successful for the remaining 4 patients (nephroscopic clearance in one and shockwave lithotripsy in 3). Tubeless PNL was performed in 17 renal units with a comparable outcome to conventional ones. The perioperative complications were noted in 5/47 (10.6%) of all procedures (Clavien Grade II in 4 and Clavien Grade IIIa in 1) and were managed conservatively.

Conclusions: Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible if performed by a well-experienced endourologist. Tubeless PNL is a better choice for children.

No MeSH data available.


Related in: MedlinePlus