Category: Clinical Stones: PCNL
Introduction & Objective :
The techniques of percutaneous nephrolithotomy (PCNL) were developed in adults but are increasingly performed in paediatric patients to treat renal stones. We present a case series of paediatric PCNLs at Guy's Hospital.
The authors retrospectively reviewed a case series of 29 paediatric PCNLs performed between 2008 and 2018 by the senior author (JG) at Guy's Hospital. A paediatric urologist was in attendance in every case. All PCNLs were performed with the patient lying prone, using ultrasound and fluoroscopic guided access, a 16 or 26Fr nephroscope and laser or ultrasonic lithitripsy. Stone size was assessed using the Guy's Stone Score (1-4). Stone size and length of stay were analysed with bivariate Pearson correlation.
Results : The mean (range) patients age was 8 years 5 months (11 months to 16 years). The mean stone size was 25.74mm; (range 10mm to 67mm). The mean Guy's Stone Score was 2.38; 10 patients had a Grade 4 stone. 3 patients had minor immediate complications (Grade 1 - Clavien-Dindo Classification). 18 patients required auxiliary procedures to further treat their stones following PCNL. Auxiliary procedures included cystourethroscopy, stent insertion, exchange, ureteroscopy and ESWL. The mean number of auxiliary procedures was 2.7 per patient. The mean (standard deviation) length of stay was 3.6 (2.2) days. Bivariate analysis showed no significant positive correlation between stone size and length of stay (correlation coefficient R2= 0.016).
Conclusions : Paediatric PCNL is a safe procedure for treating renal stones with low complication rate despite many patients presenting with complex stones. Length of stay is comparable to adults and we did not find any correlation with stone size. Paediatric PCNL is performed rarely in the UK. It should probably be performed in a small number of stone centres to build up and maintain expertise.