Percutaneous Nephrolithotomy in Pediatric Patients

Abstract

Pediatric urolithiasis is a relatively rare disease in urology. According to the American Urological Association (AUA) 2016 Surgical Treatment Guidelines, surgery is recommended for patients who are unable to pass stones spontaneously after 4–6 weeks of observation and who are unresponsive to 4–6 weeks of medical therapy. Extracorporeal shock wave lithotripsy (ESWL) is the treatment of choice in most cases involving upper urinary tract stones, while percutaneous nephrolithotripsy (PCNL) is appropriate for more complex or unique types of kidney stones. Pediatric patients require a thorough assessment and preparation prior to undergoing PCNL. Age is not a limiting factor for surgery and infants as young as a few months can safely undergo PCNL as long as appropriate surgical equipment and adjunctive therapy are used. As 75%–84% of kidney stones in children are associated with genetic metabolic disorders, and 50% of children have symptomatic recurrences within three years of their first occurrence, the number of surgeries performed throughout a child's lifetime should be minimized. Since children are growing and developing, an ultrasound-guided technique is preferred because it avoids the harmful effects of radiation. The literature reports stone-free rates after PCNL ranging from 68 to 100%. Any remaining stones can be treated with a second phase of surgery or a combination of extracorporeal shock wave lithotripsy and flexible ureteroscopy lithotripsy.