Current Urology Reports

, Volume 13, Issue 4, pp 298–306 | Cite as

Minimally Invasive Surgical Approaches to Kidney Stones in Children

  • Hasan Serkan DoganEmail author
  • Serdar Tekgul
Pediatric Urology (R Grady, Section Editor)


The existing treatment options for pediatric urolithiasis are endoscopic methods. Extracorporeal shockwave lithotripsy (SWL) is the first-line option for most of the kidney stones smaller than 1 cm in diameter. For larger stones or refractory cases, minimally invasive surgical methods are preferred. Percutaneous nephrolithotomy (PCNL) is a well-established treatment modality for most patients. This technique has shown evolution also in children so that miniaturized or tubeless methods could now be performed. Recent series show that flexible ureteroscopy is also becoming an important treatment option in the pediatric urology armamentarium for treating the calyceal and lower pole stones. Open surgery has a very limited role and it may be of use when there is a need to do an adjuvant reconstructive surgery. With the increasing experience, laparoscopic surgery is becoming an alternative option that may have potential to replace the open techniques.


Children Pediatric Kidney Stone Minimally invasive Surgery Percutaneous nephrolithotomy Flexible ureteroscopy Retrograde intrarenal surgery Laparoscopy Endoscopy 





Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Alken P. Harnsteinleiden im Kindesalter. In: Hohenfellner R, Thtiroff JW, Schulte-Wissermann H, editors. Kinderurologie in Klinik und Praxis. New York: Georg Thieme-Verlag Stuttgart Thieme; 1986. p. 572–91.Google Scholar
  2. 2.
    Stapelton FB, Kroovand RL, et al. Stones in childhood. In: Coe FL, Favus MJ, Pak CYC, editors. Kidney stones: Medical and surgical management. Philadelphia: Lippincott-Raven; 1996. p. 1065–81.Google Scholar
  3. 3.
    Bush NC, Xu L, Brown BJ, et al. Hospitalizations for pediatric stone disease in United States, 2002–2007. J Urol. 2010;183:1151–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Novak TE, Lakshmanan Y, Trock BJ, Gearhart JP, Matlaga BR. Sex prevalence of pediatric kidney stone disease in the United States: an epidemiologic investigation. Urology. 2009;74:104–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Sas DJ, Hulsey TC, Shatat IF, Orak JK. Increasing incidence of kidney stones in children evaluated in the emergency department. J Pediatr. 2010;157:132–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Tekgul S, Riedmiller H, Dogan HS, et al. Guidelines on Pediatric Urology. In: EAU Guidelines, 2012. ISBN 978-90-79754-83-0.Google Scholar
  7. 7.
    Woodside JR, Stevens GF, Stark GL, et al. Percutaneous stone removal in children. J Urol. 1985;134:1166–7.PubMedGoogle Scholar
  8. 8.
    Dwaba MS, Shokeir AA, Hafez AT, et al. Percutaneous nephrolithotomy in children: early and late anatomical and functional results. J Urol. 2004;172:1078–81.CrossRefGoogle Scholar
  9. 9.
    Samad L, Qureshi S, Zaidi Z. Does percutaneous nephrolithotomy in children cause significant renal scarring? J Pediatr Urol. 2007;3:36–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Reisiger K, Vardi I, Yan Y, et al. Pediatric nephrolithiasis: does treatment affect renal growth? Urology. 2007;69:1190–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Wadhwa P, Aron M, Bal CS, Dhanpatty B, Gupta NP. Critical prospective appraisal of renal morphology and function in children undergoing shockwave lithotripsy and percutaneous nephrolithotomy. J Endourol. 2007;21:961–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Samad L, Aquil S, Zaidi Z. Paediatric percutaneous nephrolithotomy: setting new frontiers. BJU Int. 2006;97:359–63.PubMedCrossRefGoogle Scholar
  13. 13.
    Salah MA, Toth C, Khan AM, Holman E. Percutaneous nephrolithotomy in children: experience with 138 cases in a developing country. World J Urol. 2004;22:277–80.PubMedCrossRefGoogle Scholar
  14. 14.
    Zeren S, Satar N, Bayazit Y, et al. Percutaneous nephrolithotomy in the management of pediatric renal calculi. J Endourol. 2002;16:75–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Desai MR, Kukreja RA, Patel SH, Bapat SD. Percutaneous nephrolithotomy for complex pediatric renal calculus disease. J Endourol. 2004;18:23–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Sahin A, Tekgül S, Erdem E, et al. Percutaneous nephrolithotomy in older children. J Pediatr Surg. 2000;35:1336–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Nouralizadeh A, Basiri A, Javaherforooshzadeh A, Soltani MH, Tajali F. Experience of percutaneous nephrolithotomy using adult-size instruments in children less than 5 years old. J Pediatr Urol. 2009;5:351–4.PubMedCrossRefGoogle Scholar
  18. 18.
    Unsal A, Resorlu B, Kara C, Bozkurt OF, Ozyuvali E. Safety and efficacy of percutaneous nephrolithotomy in infants, preschool age, and older children with different sizes of instruments. Urology. 2010;76:247–52.PubMedCrossRefGoogle Scholar
  19. 19.
    Dogan B, Atmaca AF, Canda AE, et al.: Efficiency of percutaneous nephrolithotomy in pediatric patients using adult-type instruments. Urol Res. 2011 Aug 5. [Epub ahead of print]Google Scholar
  20. 20.
    Jackman SV, Docimo SG, Cadeddu JA, et al. The “mini-perc” technique: a less invasive alternative to percutaneous nephrolithotomy. World J Urol. 1998;16:371–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Jackman SV, Hedican SP, Peters CA, Docimo SG. Percutaneous nephrolithotomy in infants and preschool age children: experience with a new technique. Urology. 1998;52:697–701.PubMedCrossRefGoogle Scholar
  22. 22.
    Bilen CY, Koçak B, Kitirci G, Ozkaya O, Sarikaya S. Percutaneous nephrolithotomy in children: lessons learned in 5 years at a single institution. J Urol. 2007;177:1867–71.PubMedCrossRefGoogle Scholar
  23. 23.
    Desai MR, Sharma R, Mishra S, et al. Single-step percutaneous nephrolithotomy (microperc): the initial clinical report. J Urol. 2011;186:140–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Khairy Salem H, Morsi HA, Omran A, Daw MA. Tubeless percutaneous nephrolithotomy in children. J Pediatr Urol. 2007;3:235–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Bilen CY, Gunay M, Ozden E, et al. Tubeless mini percutaneous nephrolithotomy in infants and preschool children: a preliminary report. J Urol. 2010;184:2498–502.PubMedCrossRefGoogle Scholar
  26. 26.
    • Aghamir SM, Salavati A, Aloosh M, et al.: Feasibility of Totally Tubeless Percutaneous Nephrolithotomy Under the Age of 14 Years: A Randomized Clinical Trial. J Endourol 2012, Jan 4 [Epub ahead of print]. This is the only pediatric PCNL study that shows the feasibility of totally tubeless procedure. Google Scholar
  27. 27.
    Badawy H, Salama A, Eissa M, et al. Percutaneous management of renal calculi: experience with percutaneous nephrolithotomy in 60 children. J Urol. 1999;162:1710–3.PubMedCrossRefGoogle Scholar
  28. 28.
    Guven S, Istanbulluoglu O, Ozturk A, et al. Percutaneous nephrolithotomy is highly efficient and safe in infants and children under 3 years of age. Urol Int. 2010;85:455–60.PubMedCrossRefGoogle Scholar
  29. 29.
    Dogan HS, Kilicarslan H, Kordan Y, Celen S, Oktay B. Percutaneous nephrolithotomy in children: does age matter? World J Urol. 2011;29:725–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Kumar R, Anand A, Saxena V, et al. Safety and efficacy of PCNL for management of staghorn calculi in pediatric patients. J Pediatr Urol. 2011;7:248–51.PubMedCrossRefGoogle Scholar
  31. 31.
    Gonen M, Turunc T, Ozturk B, Aygun C, Ozkardes H. Outcome of percutaneous nephrolithotomy in children having complex stones. Urol Int. 2009;83:416–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Ozden E, Sahin A, Tan B, et al. Percutaneous renal surgery in children with complex stones. J Pediatr Urol. 2008;4:295–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Anand A, Kumar R, Dogra PN, Seth A, Gupta NP. Safety and efficacy of a superior caliceal puncture in pediatric percutaneous nephrolithotomy. J Endourol. 2010;24:1725–8.PubMedCrossRefGoogle Scholar
  34. 34.
    El-Nahas AR, Shokeir AA, El-Kenawy MR, et al. Safety and efficacy of supracostal percutaneous nephrolithotomy in pediatric patients. J Urol. 2008;180:676–80.PubMedCrossRefGoogle Scholar
  35. 35.
    Abdeldaeim HM, Hamdy SA, Mokhless IA. Percutaneous nephrolithotomy for the management of stones in anomalous kidneys in children. J Pediatr Urol. 2011;7:239–43.PubMedCrossRefGoogle Scholar
  36. 36.
    Salah MA, Tallai B, Holman E, et al. Simultaneous bilateral percutaneous nephrolithotomy in children. BJU Int. 2005;95:137–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Guven S, Ozturk A, Arslan M, et al. Simultaneous bilateral percutaneous nephrolithotomy in children: no need to delay. J Endourol. 2011;25:437–40.PubMedCrossRefGoogle Scholar
  38. 38.
    Dogan HS, Tekgul S. Management of pediatric stone disease. Curr Urol Rep. 2007;8:163–73.PubMedCrossRefGoogle Scholar
  39. 39.
    Smaldone MC, Corcoran AT, Docimo SG, Ost MC. Endourological management of pediatric stone disease: present status. J Urol. 2009;181:17–28.PubMedCrossRefGoogle Scholar
  40. 40.
    Bogris S, Papatsoris AG. Status quo of percutaneous nephrolithotomy in children. Urol Res. 2010;38:1–5.PubMedCrossRefGoogle Scholar
  41. 41.
    Roth CC, Donovan BO, Adams JM, et al. Use of second look nephroscopy in children undergoing percutaneous nephrolithotomy. J Urol. 2009;181:796–800.PubMedCrossRefGoogle Scholar
  42. 42.
    Allen D, O’Brien T, Tiptaft R, Glass J. Defining the learning curve for percutaneous nephrolithotomy. J Endourol. 2005;19:279–82.PubMedCrossRefGoogle Scholar
  43. 43.
    Karami H, Rezaei A, Mohammadhosseini M, et al. Ultrasonography-guided percutaneous nephrolithotomy in the flank position versus fluoroscopyguided percutaneous nephrolithotomy in the prone position: a comparative study. J Endourol. 2010;24:1357–61.PubMedCrossRefGoogle Scholar
  44. 44.
    Osman M, Wendt-Nordahl G, Heger K, et al. Percutaneous nephrolithotomy with ultrasonography-guided renal access: experience from over 300 cases. BJU Int. 2005;96:875–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Basiri A, Mohammadi Sichani M, Hosseini SR, et al. X-ray-free percutaneous nephrolithotomy in supine position with ultrasound guidance. World J Urol. 2010;28:239–44.PubMedCrossRefGoogle Scholar
  46. 46.
    Desai M, Ridhorkar V, Patel S, Bapat S, Desai M. Pediatric percutaneous nephrolithotomy: Assessing impact of technical innovations on safety and efficacy. J Endourol. 1999;13:359–64.PubMedCrossRefGoogle Scholar
  47. 47.
    • Penbegül N, Tepeler A, Sancaktutar AA, et al.:. Safety and Efficacy of Ultrasound-guided Percutaneous Nephrolithotomy for Treatment of Urinary Stone Disease in Children. Urology2011, Dec 21. [Epub ahead of print]. This is one of the very few pediatric PCNL studies revealing the effectiveness and safety of intraoperative ultrasonography guided access establishment by the surgeon himself. Google Scholar
  48. 48.
    Guven S, Istanbulluoglu O, Gul U, et al. Successful percutaneous nephrolithotomy in children: Multicenter study on current status of its use, efficacy and complications using Clavien classification. J Urol. 2011;185:1419–24.PubMedCrossRefGoogle Scholar
  49. 49.
    •• Ozden E, Mercimek MN, Yakupoğlu YK, Ozkaya O, Sarikaya S: Modified Clavien classification in percutaneous nephrolithotomy: Assessment of complications in children. J Urol. 2011, 185:264–8. This study is important because it describes the factors affecting the complication rates in pediatric PCNL cases by a standardized classification system in association with a good statistical analysis. PubMedCrossRefGoogle Scholar
  50. 50.
    Holman E, Khan AM, Flasko T, et al. Endoscopic management of pediatric urolithiasis in a developing country. Urology. 2004;63:159–62.PubMedCrossRefGoogle Scholar
  51. 51.
    Aron M, Yadav R, Goel R, et al. Percutaneous nephrolithotomy for complete staghorn calculi in preschool children. J Endourol. 2005;19:968–72.PubMedCrossRefGoogle Scholar
  52. 52.
    Rizvi SA, Naqvi SA, Hussain Z, et al. Management of pediatric urolithiasis in Pakistan: Experience with 1,440 children. J Urol. 2003;169:634–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Gedik A, Tutus A, Kayan D, Yılmaz Y, Bircan K. Percutaneous nephrolithotomy in pediatric patients: Is computerized tomography a must? Urol Res. 2011;39:45–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Vallancien G, Capdeville R, Veillon B, Charton M, Brisset JM. Colonic perforation during percutaneous nephrolithotomy. J Urol. 1985;134:1185–7.PubMedGoogle Scholar
  55. 55.
    Skoog SJ, Reed MD, Gaudier Jr FA, Dunn NP. The posterolateral and the retrorenal colon: Implication in percutaneous stone extraction. J Urol. 1985;134:110–2.PubMedGoogle Scholar
  56. 56.
    El-Nahas AR, Shokeir AA, El-Assmy AM, et al. Colonic perforation during percutaneous nephrolithotomy: Study of risk factors. Urology. 2006;67:937–41.PubMedCrossRefGoogle Scholar
  57. 57.
    Segura JW, Patterson DE, LeRoy AJ, et al. Percutaneous removal of kidney stones: Review of 1,000 cases. J Urol. 1985;134:1077–81.PubMedGoogle Scholar
  58. 58.
    Gerspach JM, Bellman GC, Stoller ML, Fugelso P. Conservative management of colon injury following percutaneous renal surgery. Urology. 1997;49:831–6.PubMedCrossRefGoogle Scholar
  59. 59.
    Ritchey M, Patterson DE, Kelalis PP, Segura JW. A case of pediatric ureteroscopic lasertripsy. J Urol. 1988;139:1272–4.PubMedGoogle Scholar
  60. 60.
    Lesani OA, Palmer JS. Retrograde proximal rigid ureteroscopy and pyeloscopy in prepubertal children: Safe and effective. J Urol. 2006;176:1570–3.PubMedCrossRefGoogle Scholar
  61. 61.
    Abu Ghazaleh LA, Shunaigat AN, Budair Z. Retrograde intrarenal lithotripsy for small renal stones in prepubertal children. Saudi J Kidney Dis Transpl. 2011;22:492–6.PubMedGoogle Scholar
  62. 62.
    Tan AH, Denstedt JD, Razvi H. Ureteroscopy for pediatric urolithiasis: An evolving first-line therapy. Pediatric Urol. 2004;65:153–6.Google Scholar
  63. 63.
    Thomas JC, DeMarco RT, Donohoe JM, et al. Pediatric ureteroscopic stone management. J Urol. 2005;174:1072–4.PubMedCrossRefGoogle Scholar
  64. 64.
    Sofer M, Binyamini J, Ekstein PM, et al. Holmium laser ureteroscopic treatment of various pathologic features in pediatrics. Urology. 2007;69:566–9.PubMedCrossRefGoogle Scholar
  65. 65.
    Minevich E, Defoor W, Reddy P, et al. Ureteroscopy is safe and effective in prepubertal children. J Urol. 2005;174:276–9. discussion 279.PubMedCrossRefGoogle Scholar
  66. 66.
    Singh A, Shah G, Young J, et al. Ureteral access sheath for the management of pediatric renal and ureteral stones: A single center experience. J Urol. 2006;175:1080–2. discussion 1082.PubMedCrossRefGoogle Scholar
  67. 67.
    Smaldone MC, Cannon Jr GM, Wu HY, et al. Is ureteroscopy first line treatment for pediatric stone disease? J Urol. 2007;178:2128–31. discussion 2131.PubMedCrossRefGoogle Scholar
  68. 68.
    Cannon GM, Smaldone MC, Wu HY, et al. Ureteroscopic management of lower-pole stones in a pediatric population. J Endourol. 2007;21:1179–82.PubMedCrossRefGoogle Scholar
  69. 69.
    Kim SS, Kolon TF, Canter D, White M, Casale P. Pediatric flexible ureteroscopic lithotripsy: The children’s hospital of Philadelphia experience. J Urol. 2008;180:2616–9. discussion 2619.PubMedCrossRefGoogle Scholar
  70. 70.
    Corcoran AT, Smaldone MC, Mally D, et al. When is prior ureteral stent placement necessary to access the upper urinary tract in prepubertal children? J Uro. 2008;180:1861–3. discussion 1863–4.CrossRefGoogle Scholar
  71. 71.
    Tanaka ST, Makari JH, Pope 4th JC, et al. Pediatric ureteroscopic management of intrarenal calculi. J Urol. 2008;180:2150–3. discussion 2153–4.PubMedCrossRefGoogle Scholar
  72. 72.
    Dave S, Khoury AE, Braga L, Farhat WA. Single-institutional study on role of ureteroscopy and retrograde intrarenal surgery in treatment of pediatric renal calculi. Urology. 2008;72:1018–21.PubMedCrossRefGoogle Scholar
  73. 73.
    Yeow WC, Pemberton R, Barker A. Flexible ureterorenoscopy and laser lithotripsy in children. J Indian Assoc Pediatr Surg. 2009;14:63–5.PubMedCrossRefGoogle Scholar
  74. 74.
    Unsal A, Resorlu B. Retrograde intrarenal surgery in infants and preschool-age children. J Pediatr Surg. 2011;46:2195–9.PubMedCrossRefGoogle Scholar
  75. 75.
    Nerli RB, Patil SM, Guntaka AK, Hiremath MB. Flexible ureteroscopy for upper ureteral calculi in children. J Endourol. 2011;25:579–82.PubMedCrossRefGoogle Scholar
  76. 76.
    Onal B, Ozdemir F, Citgez S, et al.:. Retrograde intrarenal surgery for nephrolithiasis in a 2-year-old boy with type 1 glycogen storage disease: A case report. J Pediatr Urol 2011, Dec 17. [Epub ahead of print].Google Scholar
  77. 77.
    Christman M, Ziemba J, Casale P: Flexible ureteroscopy in children with von Willebrand disease. J Endourol 2011, Dec 28. [Epub ahead of print]Google Scholar
  78. 78.
    Tekgül S. Ureteroscopy versus shock wave lithotripsy for renal calculi in children. J Urol. 2011;185:1188–9.PubMedCrossRefGoogle Scholar
  79. 79.
    Skolarikos A, Papatsoris AG, Albanis S, Assimos D. Laparoscopic urinary stone surgery: An updated evidence-based review. Urol Res. 2010;38:337–44.PubMedCrossRefGoogle Scholar
  80. 80.
    Jordan GH, McCammon KA, Robey EL. Laparoscopic pyelolithotomy. Urology. 1997;49:131–4.PubMedCrossRefGoogle Scholar
  81. 81.
    Modi P, Goel R, Dodia S. Case report: Laparoscopic pyeloplasty with pyelolithotomy in crossed fused ectopia. J Endourol. 2006;20:191–3.PubMedCrossRefGoogle Scholar
  82. 82.
    Gupta NP, Yadav R, Singh A. Laparoscopic transmesocolic pyelolithotomy in an ectopic pelvic kidney. JSLS. 2007;11:258–60.PubMedGoogle Scholar
  83. 83.
    Casale P, Grady RW, Joyner BD, et al. Transperitoneal laparoscopic pyelolithotomy after failed percutaneous access in the pediatric patient. J Urol. 2004;172:680–3. discussion 683.PubMedCrossRefGoogle Scholar
  84. 84.
    Lee RS, Passerotti CC, Cendron M, et al. Early results of robot assisted laparoscopic lithotomy in adolescents. J Urol. 2007;177:2306–9. discussion 2309–10.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of UrologyUludag University, Faculty of MedicineBursaTurkey
  2. 2.Department of UrologyHacettepe University, Faculty of MedicineAnkaraTurkey

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