Our experience with percutaneous nephrolithotomy in preschool children

Objective: Our aim is to present our experiences with PNL performed on a group of preschool-age children in our clinics.Materials and methods: A total of 23 renal units of 23 patients (10 male, and 13 female patients) with a mean age of 4.3 months (22-72 months) underwent PNL. In 11 patients, the stones were in the right kidneys, and in 12 patients, the stones were in the left kidneys. The stones were localized in the renal pelves (n=10), lower (n=8), middle (n=5), upper pole (n=5) calices or proximal ureters (n=1). In addition, concomitant stones in the distal segment of the ipsilateral (n=2 patients) and contralateral (n=1) ureter were present. In all renal units, following the mechanical dilatation of the nephrostomy access tract, a 17-Fr nephroscope was inserted to perform PNL. Results: The mean stone surface area was 212 mm2 (110-720 mm2). Average durations of anesthesia, PNL were 77 minutes (45-155 min), and 56 minutes (19-135 min), respectively. Average fluoroscopic manipulation time was 3.4 minutes (2-8 min). To facilitate access, prior mechanical dilatation was performed. Three patients with concomitant ureteral stones underwent ureteroscopy with a 4-Fr semi-rigid ureteroscope, followed by PNL. At the end of postoperative 1 month period, 17 (74%) patients achieved a completely stone-free state, while 5 (21%) cases were fully stone-free after postoperative shock wave lithotripsy. Major bleeding was encountered in one patient after intrarenal introduction of the nephroscope closer to the stone. In 2 patients, blood replacement was also required during the early postoperative period. Average hospitalization time was 1.9 days (1-7 days). Conclusion: Although some major and minor complications were observed, PNL should be the first alternative in the management of renal stones in preschool children. Earlier recognition of complications and institution of necessary interventions on time require close collaboration with the anesthesia team.