Percutaneous Renal Surgery In Children With Complex Stones

Main Category: Urology / Nephrology
Also Included In: Pediatrics / Children's Health
Article Date: 24 Aug 2008 - 0:00 PST

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UroToday.com - This study from Turkey reported a pediatric percutaneous nephrolithotomy experience. The group retrospectively analyzed 105 patients younger than 17 years of age who underwent percutaneous nephrolithotomy. The group defined complex calculi as either a staghorn or one with a bulk larger than 3 cm² and involving more than one calix, the upper ureter, or an anomalous kidney.

The patient's mean age was 9.7 years with a mean stone burden of 6.54 cm². The mean operative time of the PCNL was 90 minutes. 73.6% of the patients were stone free after one procedure. Almost 40% of the patients required multiple tracts. The average loss of hemoglobin was 1.6 grams per deciliter. Both the number and the size of the tracts were clinically significant when correlated to the drop in hemoglobin. There was no significant change in creatinine when compared with the number of tracts.

The group concluded that percutaneous nephrolithotomy is a safe and effective management technique in the treatment of complex renal calculi in children. The tract dilation and number of tracts were important factors in reducing blood loss. Unfortunately, this paper would have been stronger if it included renal scans preoperatively and postoperative assessments of the impact of numerous tracks in children. This would have been of great clinical significance, as there have been other studies correlating renal damage with tract size and number. This paper could have put to rest or solidified any fears with such a large population of children.

Ozden E, Sahin A, Tan B, Dog(an HS, Eren MT, Tekgül S
J Pediatr Urol. 2008 Aug;4(4):295-8

Reported by UroToday.com Medical Editor Pasquale Casale, MD

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