Abstract
Purpose
To evaluate the safety and efficacy of percutaneous nephrolithotomy (PCNL) in pediatric patients with solitary kidneys and kidney stones.
Methods
Thirty-nine patients (group A) with solitary kidney under 18 years of age who underwent PCNL between January 2015 and December 2021 were evaluated and analyzed. Forty-two patients (group B) with bilateral kidneys who underwent PCNL were determined as the control group and included in the analysis. Intraoperative and postoperative data such as demographic data, stone localization, bleeding and transfusion rates, operation time, complications, hospital stay, stone-free rates (SFR) and kidney function (glomerular filtration rate (eGFR)) were compared between the two groups. PCNL was performed with all patients in the prone position. Only a laser was used to fragment the stone in all cases. Stone-free was defined as the absence of residual stone fragments ≥ 2 mm in maximum diameter at 3 months on kidney, ureter and bladder (KUB) graphy, ultrasonography (US) or non-contrast tomography (NCCT).
Results
The mean ages of the patients in Group A and B were 7.5 ± 2.6 and 8.5 ± 3.1 years, respectively. The mean stone size was 16.5 ± 4.1 and 17.0 ± 3.2 mm in group A and group B, respectively (p = 0.49). SFR rates in Groups A and B were 97.4% and 95.2% (p = 1.00). There was no statistically significant difference in terms of the operation time, perioperative blood transfusion, hemoglobin decrease and Clavien grade 1 complication rates (p > 0.05). However, double-J (JJ) stent placement, duration of nephrostomy and hospital stay were longer in the solitary kidney group (p < 0.05). There was a significant improvement in creatinine and eGFR levels in both groups at the postoperative sixth month (p < 0.05).
Conclusion
Our results show that PCNL is a safe and effective method in pediatric patients with solitary kidneys.
Similar content being viewed by others
References
Schwarz RD, Dwyer NT (2006) Pediatric kidney stones: long-term outcomes. Urology 67(4):812–816. https://doi.org/10.1016/j.urology.2005.10.020
Tekgül S, Stein R, Bogaert G, Nijman RJ, Quaedackers J, Silay MS et al (2021) European association of urology and European society for paediatric urology guidelines on paediatric urinary stone disease. Eur Urol Focus. https://doi.org/10.1016/j.euf.2021.05.006
Nouralizadeh A, Basiri A, Javaherforooshzadeh A, Soltani MH, Tajali F (2009) Experience of percutaneous nephrolithotomy using adult-size instruments in children less than 5 years old. J Pediatr Urol 5(5):351–354. https://doi.org/10.1016/j.jpurol.2008.12.009
Schuster TK, Smaldone MC, Averch TD, Ost MC (2009) Percutaneous nephrolithotomy in children. J Endourol 23(10):1699–1705. https://doi.org/10.1089/end.2009.0198
Soucy F, Ko R, Duvdevani M, Nott L, Denstedt JD, Razvi H (2009) Percutaneous nephrolithotomy for staghorn calculi: a single center’s experience over 15 years. J Endourol 23(10):1669–1673. https://doi.org/10.1089/end.2009.1534
Wolf JS Jr, Clayman RV (1997) Percutaneous nephrostolithotomy: what is its role in 1997? Urol Clin N Am 24(1):43–58. https://doi.org/10.1016/S0094-0143(05)70353-0
Shokeir AA, Sheir KZ, El-Nahas AR, El-Assmy AM, Eassa W, El-Kappany HA (2006) Treatment of renal stones in children: a comparison between percutaneous nephrolithotomy and shock wave lithotripsy. J Urol 176(2):706–710. https://doi.org/10.1016/j.juro.2006.03.080
Onal B, Dogan C, Citgez S, Argun B, Onder AU, Sever L, Erozenci A (2013) Percutaneous nephrolithotomy in children with cystine stone: long-term outcomes from a single institution. J Urol 190(1):234–238. https://doi.org/10.1016/j.juro.2013.01.016
Cockcroft DW, Gault H (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16(1):31–41. https://doi.org/10.1159/000180580
Fernström I, Johansson B (1976) Percutaneous pyelolithotomy: a new extractio technique. Scand J Urol Nephrol 10(3):257–259. https://doi.org/10.1080/21681805.1976.11882084
Helal M, Black T, Lockhart J, Fıgueroa TE (1997) The Hickman peel-away sheath: alternative for pediatric percutaneous nephrolithotomy. J Endourol 11(3):171–172. https://doi.org/10.1089/end.1997.11.171
Jackman SV, Hedican SP, Peters CA, Docimo SG (1998) Percutaneous nephrolithotomy in infants and preschool age children: experience with a new technique. Urology 52(4):697–701. https://doi.org/10.1016/S0090-4295(98)00315-X
Sabnis RB, Jagtap J, Mishra S, Desai M (2012) Treating renal calculi 1–2 cm in diameter with minipercutaneous or retrograde intrarenal surgery: a prospective comparative study. BJU Int 110(8):E346. https://doi.org/10.1111/j.1464-410X.2012.11089.x
Proietti S, Giusti G, Desai M, Ganpule AP (2017) A critical review of miniaturised percutaneous nephrolithotomy: is smaller better? Eur Urol Focus 3(1):56–61. https://doi.org/10.1016/j.euf.2017.05.001
Koga S, Arakaki Y, Matsuoka M, Ohyama C (1991) Staghorn calculi–long-term results of management. Br J Urol 68(2):122–124. https://doi.org/10.1111/j.1464-410X.1991.tb15278.x
El-Nahas AR, Shokeir AA, El-Assmy AM, Mohsen T, Shoma AM, Eraky I, El-Kappany HA (2007) Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. J Urol 177(2):576–579. https://doi.org/10.1016/j.juro.2006.09.048
Darabi MM, Shakibi MH (2008) Percutaneous nephrolithotomy in patients with solitary kidney. Urol J 5(1):24–27. https://doi.org/10.22037/uj.v5i1.67
Bucuras V, Gopalakrishnam G, Wolf JS Jr, Sun Y, Bianchi G, Erdogru T, de la Rosette J, on behalf of the CROES PCNL Study Group (2012) The clinical research office of the endourological society percutaneous nephrolithotomy global study: nephrolithotomy in 189 patients with solitary kidneys. J Endourol 26(4):336–341. https://doi.org/10.1089/end.2011.0169
Resorlu B, Kara C, Oguz U, Bayindir M, Unsal A (2011) Percutaneous nephrolithotomy for complex caliceal and staghorn stones in patients with solitary kidney. Urol Res 39(3):171–176. https://doi.org/10.1007/s00240-010-0321-2
Akman T, Binbay M, Tekinarslan E, Ozkuvanci U, Kezer C, Erbin A, Yaser-Muslumanoglu A (2011) Outcomes of percutaneous nephrolithotomy in patients with solitary kidneys: a single-center experience. Urology 78(2):272–276. https://doi.org/10.1016/j.urology.2010.12.029
Jones P, Bennett G, Aboumarzouk OM, Griffin S, Somani BK (2017) Role of minimally invasive percutaneous nephrolithotomy techniques—micro and ultra-mini PCNL (<15F) in the pediatric population: a systematic review. J Endourol 31(9):816–824. https://doi.org/10.1089/end.2017.0136
Ganpule AP, Mishra S, Desai MR (2010) Percutaneous nephrolithotomy for pediatric urolithiasis. Indian J Urol 26(4):549. https://doi.org/10.4103/0970-1591.74458
Kaygısız O, Satar N, Güneş A, Doğan HS, Erözenci A, Özden E, Önal B (2018) Factors predicting postoperative febrile urinary tract infection following percutaneous nephrolithotomy in prepubertal children. J Pediatr Urol 14(5):448-e1. https://doi.org/10.1016/j.jpurol.2018.04.010
Agrawal MS, Agarwal M (2013) Percutaneous nephrolithotomy: large tube, small tube, tubeless, or totally tubeless? Indian J Urol 29(3):219. https://doi.org/10.4103/0970-1591.117285
Celik H, Camtosun A, Dede O, Dagguli M, Altintas R, Tasdemir C (2017) Comparison of the results of pediatric percutaneous nephrolithotomy with different sized instruments. Urolithiasis 45(2):203–208. https://doi.org/10.1007/s00240-016-0887-4
Funding
No financial support has been received for this study.
Author information
Authors and Affiliations
Contributions
K.K. and H.E. wrote the main manuscript text and K.K. prepared tables 1-3. All authors reviewed the manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Karkin, K., Erçil, H. Is percutaneous nephrolithotomy effective and safe for children with solitary kidney?. Pediatr Surg Int 38, 1171–1175 (2022). https://doi.org/10.1007/s00383-022-05147-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-022-05147-6