Simultaneous bilateral percutaneous nephrolithotomy in children

Abstract

In the paediatric section, two papers relating to the upper urinary tract are presented. The first, from Hungary, describes simultaneous bilateral percutaneous nephrolithotomy in 13 patients, where it was deemed feasible; this is the first such report. Authors from London report on unilateral nephrectomy in patients with nephrogenic hypertension, and found that it was successful in normalising blood pressure in patients with renal hypertension with a normal contralateral kidney. OBJECTIVE To evaluate the efficacy of removing bilateral kidney stones simultaneously from children, in one session. PATIENTS AND METHODS Thirteen patients (three girls and 10 boys, 26 kidneys; mean age 8 years, range 3–14) underwent simultaneous bilateral percutaneous nephrolithotomy (PCNL) in the same session, under general anaesthesia, starting with ureteric catheter insertion into both kidneys and using a 26 F adult nephroscope. The mean (range) stone diameter was 2 (1–3.5) cm. Three patients had staghorn stones in one of their kidneys. Ultrasonic disintegration was used; two patients had bilateral and two others unilateral endopylotomy, and one patient had percutaneous suprapubic cystolithotomy in the same session. The mean (range) operative duration was 65 (55–90) min. RESULTS All patients were rendered stone‐free; there was no severe bleeding or any other complication. On one side in one of the patients, a second session was needed because of residual stone. The nephrostomy tubes were removed 3 and 4 days after PCNL and the hospital stay was 6 (1–11) days. CONCLUSION The advantages of simultaneous bilateral PCNL are reduced psychological stress, one cystoscopy and anaesthesia, less medication and a shorter hospital stay and convalescence, with considerable savings in cost. In experienced hands this method can be used not only in adults but also in children. To our knowledge this is the only report of this technique in children.

Paediatric percutaneous nephrolithotomy: setting new frontiers

“…The results are equally good, with high patient satisfaction. A comparable series of children undergoing bilateral simultaneous PCNL was recently published by Salah et al [23]; they reported similar satisfactory outcomes, with the added benefit of decreased healthcare costs.…”

Pediatric urolithiasis: the current surgical management

“…Reported complications of PCNL include postoperative fever (30%) and bleeding, the latter being the most reported complication associated with PCNL and consecutive transfusion rates ranging from 0% to 23.9% [37, 38, 44–48]. The risk for blood transfusions is generally very low, with the report of one transfusion in 287 procedures in four pediatric studies [38, 44, 45, 47]. The highest reported number of transfusions needed (23.9%, or 16 out of 67) was by Zeren et al, which occurred mainly during their early PCNL procedures.…”

Management of multiple stones in a single session using minimally invasive methods in infants with renal failure: renal salvage

“…The reports related with bilateral PCNL in children are scarce. Salah et al [12] first evaluated the results of 13 children (average age: 8 years) with bilateral kidney stones and reported the advantages of simultaneous bilateral PCNL as reduced psychological stress, one cystoscopy and anesthesia, less medication, and a shorter hospital stay and convalescence, with considerable savings in cost. The youngest patient in their study was 3 years old.…”