Percutaneous nephrolithotomy in children in different age groups

INTRODUCTION & OBJECTIVES: To present the overall results of pediatric percutaneous nephrolithotomy (PCNL) in addition to the indications, complications and outcomes according to the different age groups treated in the participating centers in the PCNL Global Study. MATERIAL & METHODS: The Clinical Research Office of the Endourological Society (CROES) study was conducted between November 2007 and December 2009, including 96 centers and more than 5800 patients. All children aged 14 years and under in the PCNL Global Study database are the focus of the study. After a general evaluation of PCNL results in children, cases were further divided into three age categories based on the World Health Organization classification as: Infants (≤1 year), young children (2-4 years) and school-age children (5-14 years). For the purpose of comparison of PCNL results between adults and children, patients were divided as 0- 14 years of age and 15 years and older. RESULTS: One hundred seven children aged 14 years and younger were included in the analysis. A considerable number (45.7%) of patients had a previous history of stone intervention. PCNL procedure was conducted in 13 patients (12.1%) in the supine position, 15 patients (14%) had tubeless PCNL, and in 22 patients (20.5%) balloon dilatation was preferred. Overall mean operation time was 97.02 min; blood transfusion rate, fever and stone free rates were 9%, 14% and 70.1%, respectively. In the comparison of adult and pediatric cases, preoperative positive urine culture was higher in the adult group (p=0.014). While a considerable percentage of adult patients had comorbidities, one child had cardiovascular disease. In operative details, mean dilatation method, mean sheath size, mean nephrostomy tube size, and methods for confirming stone-free status were different between children and adults; however, the surgical outcomes were comparable. On categorizing the pediatric PCNL cases according to age groups, no statistically significant differences were found among the subgroups with regard to patient characteristics, co-morbidities, renal anomalies, or previous surgical history. In the evaluation of the operative details, mean sheath size and nephrostomy tube size were larger in school-age children compared to the preschool children (p=0.01 and 0.002, respectively). There was a difference in the preferred methods for confirming stone-free status, with ultrasonography preferred more in preschool children (p=0.0002). The PCNL procedure position, puncture site, dilatation method, postoperative tube application, and surgical outcomes were comparable in school- and preschool- age children. CONCLUSIONS: Based on the findings of the present study, we can suggest that PCNL can be applied safely and effectively in children of all ages, including infants. Outcomes appear comparable with those in adults with respect to the success and complication rates, provided that substantial indications, equipment and experience are present.