Percutaneous nephrolithotomy for pediatric renal calculus disease: 5 years of local experience.

INTRODUCTION: Pediatric renal calculus disease has been considered a management dilemma. The various treatment modalities have different effects on the growing kidney, with concern to the significant recurrence rate, and the long-term outcome. We report our experience with performing percutaneous nephrolithotomy (PCNL) monotherapy in staghorn or complex pediatric renal calculi. PATIENTS AND METHODS: We retrospectively analyzed the results of PCNL in 9 children treated at our institute between 2001 and 2006. A total of 9 children (10 renal units) with a mean age of 10.1 years underwent 10 percutaneous nephrolithotomies (PCNLs). One patient underwent bilateral percutaneous nephrolithotomy at the initial presentation. The average calculus size was 45.9 mm (range 15-65 mm). Of the patients, 7 had complete or partial staghorn, 1 was a shock wave lithotripsy (SWL) failure, and 1 had a stone located in a lower calyx with a narrowed infundibulum; 7 from the 9 patients turned out to have some kind of a metabolic disorder--cystinuria in 6 patients and hyperoxaluria in one patient. The operations were performed under the guidance of monoplane fluoroscopy--standard PCNL in 3 cases and percutaneous nephrolithotomy with minimal access (mini-perc) in 7 cases. A rigid nephroscope was used in all of the cases. The stones were fragmented with pneumatic or ultrasonic devices and extracted with forceps. RESULTS: Stone-free status was achieved in 8 renal units (80%) after a single stage PCNL. With subsequent shock wave lithotripsy (SWL), the clearance rate had increased to 100%. The mean operating time was 88 minutes (range, 35 to 180 minutes) and no intraoperative or postoperative major complications were observed and no blood transfusions were required. One patient had suffered from intraoperative hypothermia, which had responded to conservative treatment. CONCLUSIONS: PCNL is an effective and safe form of therapy in pediatric stone disease. Since two-thirds of pediatric stone patients have an underlying metabolic disorder, a close cooperation of adult and pediatric urologists, nephrologists and radiologists is necessary in order to achieve good results in the treatment of pediatric nephrolithiasis.

Anesthetic considerations during percutaneous nephrolithotomy.

STUDY OBJECTIVE: To assess anesthesia-related complications during and following percutaneous nephrolithotomy (PCNL) for staghorn stones. DESIGN: Prospective study and a detailed case report. SETTING: Medical center in southern Israel. PATIENTS: 20 consecutive patients undergoing PCNL for staghorn stones. INTERVENTIONS: All patients underwent PCNL during general anesthesia. MEASUREMENTS: Duration of surgery, esophageal temperature, hemoglobin (Hb) concentration, and requirements for blood transfusion, mean volume of irrigation fluid, and serum sodium and potassium concentration were recorded. MAIN RESULTS: Mean age was 50.7 +/- 14.9 y (range, 26-76 y). Mean duration of the procedure was 120.0 +/- 42.5 min (range, 75-240 min). Mean volume of irrigation fluid was 34.1 +/- 15.3 L (range, 18-80 L). There was a significant decrease in Hb concentration from 13.7 +/- 1.71 to 12.2 +/- 1.4 g/dL, but no patient required blood transfusion. There was a statistically significant reduction in esophageal temperature from 36.4 degrees C +/- 0.32 degrees C to 35.2 degrees C +/- 0.5 degrees C. There were no significant changes in sodium or potassium concentration before or after PCNL. CONCLUSIONS: Anesthesia during PCNL for staghorn stones is a challenge because of the possibility of fluid absorption, dilutional anemia, hypothermia, or significant blood loss.