The Role of Percutaneous Nephrolithotomy in the Management of Pediatric Renal Calculi

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Abstract
Minimally invasive techniques for the treatment of urinary calculi in children are recommended due to an increased probability of recurrence. Percutaneous nephrolithotomy is well established in adults but to our knowledge this procedure has not been reported previously in a large series of children. We review our experience with percutaneous nephrolithotomy in children. From 1987 to 1995 percutaneous nephrolithotomy was performed in 25 children 3 to 16 years old (median age 8). Indications for percutaneous nephrolithotomy were an obstructed kidney in 10 cases, large stone size or staghorn calculus in 8, failed extracorporeal shock wave lithotripsy in 4 and residual stones after open surgery in 3. There were 15 solitary renal, 4 staghorn and 2 upper ureteral stones, and 5 children had multiple renal calculi. Percutaneous nephrolithotomy was performed once in 22 patients, and 2, 3 or 5 times in the remainder. Of the 25 patients 17 (68%) were stone-free at hospital discharge or shortly thereafter following a single session of percutaneous nephrolithotomy. Retained calculi after a single percutaneous nephrolithotomy treatment were much more common with staghorn stones (2 of 4 cases or 50%) and multiple stones (3 of 5 or 60%) compared to solitary renal stones (2 of 15 or 13.3%). With subsequent extracorporeal shock wave lithotripsy or repeat percutaneous nephrolithotomy the stone clearance rate was as high as 92%. At a 2 to 66-month followup (average 23) no late complications were noted. Radioisotope scans available in 10 cases before and after percutaneous nephrolithotomy revealed unchanged differential function and evidence of significant renal scars in only 1. Percutaneous nephrolithotomy is a suitable and safe procedure for treating renal stones in children.