Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

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PERCUTANEOUS NEPHROLITHOTOMY IN CHILDREN: A PRELIMINARY CASE

REPORT

Luis ALONSO-JIMENEZ

, Gustavo DELGADO-DUATIS

, Oscar GOMEZ-BELTRAN

, Francisco VEGA-BURGOS

, Alvaro

JUAREZ

and J.L. ALVAREZ-OSSORIO

1) HOSPITAL UNIVERSITARIO PUERTA DEL MAR, PEDIATRIC SURGERY, Cadiz, SPAIN - 2) HOSPITAL DE JEREZ,

UROLOGY, Jerez, SPAIN - 3) HOSPITAL UNIVERSITARIO PUERTA DEL MAR, UROLOGY, Cadiz, SPAIN

PURPOSE

The incidence of stone disease has been increasing and the risk of recurrent stone formation is high in a pediatric

population. The options for management for upper tract urolithiasis include shock wave lithotripsy (SWL), percutaneous

nephrolithotomy (PNL), retrograde intrarenal surgery (RIRS), and open / laparoscopic stone surgery. Recently,

endoscopic methods have been safely and effectively used in children with minor complications. As a low-risk procedure

with a high retreatment rates (18–67 %), SWL often leads to persistent residual stones. The developing RIRS can

minimize the risks associated with bleeding and visceral injury, but there are cases in which the pelvicalyceal anatomy is

not ideal, and because of the anatomical delicacy of pediatric ureter, flexible ureteroscopy may not be an ideal option.

Being a safe procedure in adults, PNL was first described in children by Woodside et al. in 1985, with total stone removal

in one session, using standard adult instruments. Ever since then, there have been multiple studies by various authors

in pediatric PNL.

MATERIAL AND METHODS

In this video, we describe the PNL procedure, emphasizing the essential points of PNL, in a 8 years child with a stone in

renal pelvis of 2.4 cm with bilateral renal atrophy due to reflux nephropathy.

RESULTS

Percutaneous nephrolithotomy for pediatric renal stones >2 cm is associated with less hospital stay, less blood

transfusion and less renal damage, compared with open surgery. Both techniques had comparable outcome and

complications. Moreover, the operative time is not significantly longer with the use of pediatric nephroscopes. We did

not notice any recurrence after our short follow-up (12 months).

CONCLUSIONS

Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible in selected cases after an

extensive learning curve.