Children versus adults undergoing percutaneous nephrolithotomy: a prospective comparative study
Wu Wenzhen1, Zhao Zhijian1, Zhong Wen1, Yuan Jian1, Dan Chichang1, Liu Guanzhao1, Guo Bin1, Li Xun1, Wu Kaijun1, Cheng Wenzhong1, Wu Wenqi1, Liu Yongda1, Qi Defeng1, Zhang Ze1, Zeng Guohua1
1Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou,510230, China
Abstract：Objective:As almost any version of percutaneous nephrolithotomy (PCNL) has been proven to be safe and efficacious in treating both pediatric and adult patients without age being a limiting risk factor, the aim of the study was to compare the differences of the operation parameters, the safety and efficacy of PCNL between children and adults.Methods:The data of 331 renal units in children and 8537 renal units in adults that had undergone MPCNL for upper urinary tract stones between the years of 2000-2012 were compared and reviewed.Results:The children had a smaller stone size but a similar stone type (number and locations) compared to adults. Usage of multiple tracts, sheath size, mean operative time and hemoglobin drop was significantly lower or shorter in children (P＜0.05 for all). Stone clearance after a single session of MPCNL was 80.4% in the children and 78.6% in adults (P＝0.001), which increased to 94.7% and 93.5% after auxiliary procedures (P＝0.44). Overall complications (15.6% vs.16.3%), and blood transfusion rate (3.1%∶2.9%) were similar in both groups (P＞0.05 for all). Both groups had low rate of high grade Clavien complications. There was no grade Ⅲ,Ⅳ,Ⅴ complications in pediatric group. For patients requiring multiple tracts, the blood transfusion was significant increase in children than adults (P＝0.007).Conclusions:This contemporary largest-scale analysis confirms that the stone-free rate in pediatric patients is at least as good as in adults without an increase of complication rates. However, multiple percutaneous nephrostomy tracts should be practiced with caution in children.
[1]Guven S, Frattini A, Onal B, et al. Percutaneous nephrolithotomy in children in different age groups: data from the Clinical Research Office of the Endourological Society (CROES) Percutaneous Nephrolithotomy Global Study.BJU Int, 2013, 111(1):148-156. [2]Desai MR, Kukreja RA, Patel SH, et al. Percutaneous nephrolithotomy for complex pediatric renal calculus disease. J Endourol, 2004, 18 (1):23-27. [3]Bilen CY, Gunay M, Ozden E, et al. Tubeless mini percutaneous nephrolithotomy in infants and preschool children: a preliminary report. J Urol, 2010, 184(6): 2498-2502. [4]Tefekli A, Ali Karadag M, Tepeler K, et al. Classification of percutaneous nephrolithotomy complications using the modified Clavien grading system: looking for a standard. Eur Urol,2008, 53(1):184-190. [5]Smaldone MC, Docimo SG, Ost MC. Contemporary surgical management of pediatric urolithiasis. Urol Clin North Am,2010, 37(2):253-267. [6]Afshar K, McLorie G, Papanikolaou F, et al. Outcome of small residual stone fragments following shock wave lithotripsy in children. J Urol, 2004, 172 (4 Pt 2):1600-1603. [7]Bilen CY, Koak B, Kitirci G, et al. Percutaneous nephrolithotomy in children: lessons learned in 5 years at a single institution. J Urol,2007, 177(5):1867-1871. [8]Badawy H, Salama A, Eissa M, et al. Percutaneous management of renal calculi: experience with percutaneous nephrolithotomy in 60 children. J Urol, 1999, 162(5):1710-1713. [9]Salah MA, Tóth C, Khan AM, et al. Percutaneous nephrolithotomy in children: experience with 138 cases in a developing country. World J Urol, 2004, 22(4):277-280. [10]Ozden E, Sahin A, Tan B, et al. Percutaneous renal surgery in children with complex stones. J Pediatr Urol,2008, 4(4):295-298. [11]Aron M, Yadav R, Goel R, et al. Percutaneous nephrolithotomy for complete staghorn calculi in preschool children. J Endourol,2005, 19(8):968-972. [12]Zeren S, Satar N, Bayazit Y, et al. Percutaneous nephrolithotomy in the management of pediatric renal calculi. J Endourol,2002, 16(2):75-78. [13]Manohar T, Ganpule AP, Shrivastav P, et al. Percutaneous nephrolithotomy for complex caliceal calculi and staghorn stones in children less than 5 years of age. J Endourol, 2006, 20(8):547-551. [14]Samad L, Qureshi S, Zaidi Z. Does percutaneous nephrolithotomy in children cause significant renal scarring? J Pediatr Urol,2007, 3(1):36-39. [15]Ozden E, Mercimek MN, Yakupolu YK, et al. Modified Clavien classification in percutaneous nephrolithotomy: assessment of complications in children. J Urol, 2011, 185(1):264-268.
