Résumé
Background: Percutaneous nephrolithotomy (PCNL) has become a well-established procedure for the management of pediatric renal calculi. Paediatric PCNL has been performed using both adult and paediatric instruments. Objectives: To evaluate the safety, efficacy and complications using the Modified Clavien scoring system (MCSS) in children undergoing PCNL using adult sized instruments.Methods: All patients less than 16 years old were analyzed retrospectively in Western Rajasthan undergoing PCNL procedure at Dr. SN Medical College and Hospital from April 2016 to March 2019. All PCNL procedures were performed in prone position under general anaesthesia with fluoroscopic guidance and using adult size instruments. All the demographics, surgical data and perioperative information were collected.Results: Total 112 patients with 120 renal units (8 patients with bilateral stones), (66 boys and 46 girls), with a mean (range) age was 10.01±4.02 (2-16) years. The mean (range) stone size in our study was 28.94±1.10 (20-50 mm). Overall, stone-free rate after PCNL was 95%. Twenty five (25) children (20.8%) had operative complications; 23/25 (92%) had, Clavien grade I in 15 (60%), grade II in 8(32%) and all managed conservatively. 2 patients had hydropneumothorax, managed with ICD tube. Stone size, operative duration and haemoglobin drop were significantly associated with complications on Univariate analysis (p<0.05).Conclusions: In paedriatric age group PCNL is considered safe with MCSS showing grade I and grade II complications in majority (92%) of patients.
Résumé
Background: Pediatric urolithiasis results in significant morbidity in later life. Incidence as well as site and chemical composition of calculi varies according to the changes in socio-economic conditions over time and the subsequent changes in dietary habits leading to a marked variation in the spectrum of urinary stone composition. To evaluate the spectrum of urinary stone composition in pediatric population from North-western India.Methods: This was a prospective observational study conducted between October 2013 and February 2019 which included pediatric patients with urolithiasis. Demographic and epidemiological characteristics including age, sex, geography, religion, socio-economic status, dietary habits were recorded. The location and sizes of stones were documented. The data was collected, analyzed and presented using summary statistics.Results: A total of 163 patients with urolithiasis were enrolled, of which 86 (53%) aged between 6 and 10 years, 49 (30%) aged between 11 and 14 years and 28 (17%) were aged between 0 and 5 years. The majority of patients were male (n=134; 82.21%). The most common location of the stone was urinary bladder (n=106; 65.03%) followed by kidney (n=33; 20.25%), urethra (n=16; 9.82%) and ureter (n=8; 4.91%). The upper tract (kidney and ureter) to the lower tract (bladder and urethra) stone ratio was 1:4. Stones with mixed composition were more than pure stones (73.62% versus 26.38%). The most common composition was the mixed stone of calcium oxalate, calcium phosphate and uric acid (n=36; 22.09%) followed by mixed stone of calcium oxalate monohydrate and dihydrate with uric acid (n=29; 17.79%), calcium oxalate and uric acid (n=25, 15.34%), calcium oxalate and calcium phosphate (n=20; 12.27%). Calcium oxalate was present in 80% of the stones, followed by uric acid in 7%, struvite in 6%, cystine in 3% and calcium phosphate in 2%.Conclusions: These results suggest that the prevalence of mixed stones with calcium oxalate as the predominant chemical component in the urinary stones of pediatric patients studied.