Percutaneous Nephrolithotomy in Paediatric Population: A Single Center Experience.

BACKGROUND: Management of paediatric stone disease is challenging as they are considered high risk group. Percutaneous nephrolithotomy is minimally invasive procedure with definite advantages in terms of higher stone clearance in single session and no long term effect in renal function. METHODS: Retrospective study was done including all patients upto the age of 18 years who underwent Percutaneous nephrolithotomy from January 2010 to December 2018 in our center after taking approval from ethical committee. Data was collected regarding gender, operative side, operative time duration, hospital stay, post-operative decrease in hemoglobin, stone size, Guy's stone score and early post-operative complications with Clavien-Dindo grade. RESULTS: Percutaneous nephrolithotomy was done in 48 renal units in 44 patients. 28 patients were boys and 16 were girls with mean age of 10.91 ± 5.22 years and mean stone size 17.16 ± 6.43 mm. 91.6% of cases had Guy's stone score of 1 and 2. Standard percutaneous nephrolithotomy was done in 21 renal units, mini percutaneous nephrolithotomy in 24 renal units and supermini percutaneous nephrolithotomy was done in three renal units with total stone free rate of 93.4%. Three patients required extracorporeal shockwave lithotripsy for significant residual stone. Average post-operative hemoglobin drop was 1.2 gm%. Overall complications rate was 18.1% with 4.5% of complications being grade 1 and 2 whereas 13.6% were Grade 3. CONCLUSIONS: Percutaneous nephrolithotomy is safe and feasible in paediatric patients with large stone burden, complex anatomy or shock-wave lithotripsy failure with acceptable complication and stone free rate.

Impact of Miniaturization on Early Outcome of Percutaneous Nephrolithotomy.

BACKGROUND: Percutaneous nephrolithotomy has become the standard procedure for large renal stones but still remains highly challenging due to complications such as bleeding and sepsis, even though it has high stone free rate (SFR). We report the early outcomes of more than 1000 percutaneous nephrolithotomys done in our center. METHODS: A retrospective study of all patients undergoing percutaneous nephrolithotomy from January 2010 to December 2017 in single institution was conducted. All cases were stratified into three groups based on tract size; standard percutaneous nephrolithotomy with tract size ? 22 F, mini percutaneous nephrolithotomy with tract size 15 - 20 F and ultramini percutaneous nephrolithotomy with tract size ? 14 F. Age, gender, stone complexity using Guy's stone score, stone size, operative time, hemoglobin drop, hospital stay, early major and minor complications were reviewed. RESULTS: A total of 1074 patients had undergone percutaneous nephrolithotomy among which, 578 patients were standard percutaneous nephrolithotomy, 433 mini percutaneous nephrolithotomy and 63 had undergone ultramini percutaneous nephrolithotomy. There was even distribution of patients with Guy's stone score 1 and 2 in all three groups. However, majority of patients with Guy's stone score 3 underwent standard percutaneous nephrolithotomy or mini percutaneous nephrolithotomy and no patients with Guy's stone score 4 underwent ultramini percutaneous nephrolithotomy. Age group, gender and operative time were comparable between the groups; however, significant difference was noted in terms of less hemoglobin drop and shorter hospital stay (p-value < 0.05) in the miniaturized percutaneous nephrolithotomy group. Complications were found to be fewer in mini percutaneous nephrolithotomy and ultramini percutaneous nephrolithotomy group in comparison to standard percutaneous nephrolithotomy. CONCLUSIONS: Miniaturization of tract size significantly decreases post-operative complication rates, blood loss and hospital stay while maintaining high stone free rates in well selected patients undergoing Percutaneous nephrolithotomy.