Percutaneous nephrolithotomy for treating renal calculi in children

There are various topics covered in the paediatric section this month. Another series of percutaneous nephrolithotomy is reported, as is the necessity or not to use the GFR in the follow‐up of children who have had a unilateral nephrectomy. In addition, authors from the USA present a new classification for genital ambiguity and urogenital sinus anomalies. They entitle it the PVE classification, and conclude that it is very helpful in surgical planning and in surgical outcomes research. OBJECTIVE To report our experience with the percutaneous management of renal stone disease in children. PATIENTS AND METHODS The medical and radiological records of children up to 18 years old who were treated for renal calculi by percutaneous nephrolithotomy (PCNL) at our institution between March 1995 and April 2003 were reviewed. For stone removal a special paediatric 18 F access sheath was used. RESULTS In all, 26 PCNLs were used in 23 patients (10 boys and 13 girls, aged 1.7–16.8 years). The presenting symptoms were urinary tract infection, abdominal pain and/or haematuria. Of the 23 patients, 17 (75%) had associated metabolic disease or underlying urological anatomical abnormalities. Urinary tract infections were found in 15 patients (65%). The mean (range) stone burden was 6.0 (0.5–18.2) cm2, and the operative duration 127 (50–260) min. The primary stone‐free rate was 58%, which increased to 81% after treating residual fragments. One blood transfusion was required and one patient developed urosepsis after PCNL, which was treated with antibiotics. CONCLUSION PCNL is an effective alternative for treating renal stones in children, and is the treatment of choice for stones refractory to extracorporeal shock wave lithotripsy.