Category: Clinical Stones: Pediatrics
Introduction & Objective :
Management of kidney stone disease in pediatric population is a challenging condition in urology practice. Percutaneous nephrolithotomy (PCNL) is a challenging procedure in pediatric population because of the small kidney and the low tolerance to blood loss.
Our objective is to evaluate the feasibility, safety and efficacy of pediatric supine (PCNL). In the literature, there are very limited data about supine PCNL in the pediatric age group.
Supine PCNL was performed in 40 children between July 2015 and April 2018. All of them were performed by a single puncture into the lower calyx under ultrasounic and fluoroscopic guidance. The tract was created by balloon dilatation. Lithotripsy was done using ultrasonic in all of patients and laser in part of them.
In this study the clinical data of the 40 patients was analyzed (20 males and 20 females). Mean age was 6 years (range 1-15). The first presenting symptom/diagnosis was flank pain in 30 (75%), sepsis 5( 13%), urinary tract infection 12 (30%), renal failure 4 (10%), asymptomatic 1 (2.5%) . Mean stone burden was 2.5 cm (range 1.7 – 6). The stones were: large stone occupying the renal pelvis and ureteropelvic junction, staghorn and multiple calyceal stones in 24 (60%),8 (20%) and 8 (20%) respectively. The stones were radiopaque in 31(78%) and radiolucent in 9 (22%). 21(52%) have a history of previous urological procedures including endourological procedures in 15 (37%) and open nephrolithotomy in 6 (15%). 10 (25%) have comorbidities including: 1 congenital short neck, 1 silver russel syndrome, 1 cerebral palsy, 1 hemophilia, 1 single kidney and 5 chronic anemia . Stent was kept postoperatively in 15 (38%) including: was inserted intraoperatively antegradelly, postoperatively and previous stent kept in 10, 3, 2 patients respectively. Two patients received intraoperative blood transfusion (5%). Mean hospital stay was 4 days. Stone-free rate was 83% after 1 session of PCNL. Postoperative urinary leakage occurred in one patient (2.5%). Postoperative sepsis occurred in 4 patients (10%).
Conclusions : Supine PCNL in pediatric age group was proved to be safe and effective in management of various stone sizes and location, with high success rate in a single step It provides stone clearance rate comparable with that reported of conventional PCNL in the prone position.
SAINT JOSEPH'S HOSPITAL
Jerusalem, Yerushalayim, Israel
Name: Tamer Abdeen, MD
Title: Specialist Urologist
Affiliation: Saint Joseph's Hospital,Jerusalem,Israel
MD ,Jordanian University of Science and Technology, Jordan, 2005
Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel ,2007-2013