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Percutaneous Nephrolithotomy in Children
Cullen Jumper, MD1, Daniel Herz, MD1, Leslie McQuiston, MD1, Dianne Sacco, MD2, Vernon Pais, Jr., MD1.
1Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, 2Massachusetts General Hospital, Boston, MA, USA.

BACKGROUND:
Percutaneous nephrolithotomy (PCNL) is uncommonly employed for large renal stones in pediatric patients in the United States, although it allows excellent stone-free rates with few ancillary procedures in adults. At our institutions, PCNL are most commonly performed by adult urologists who were thus recruited to assist in PCNL in children. Results of this multidisciplinary approach and the characteristics of these patients are seldom reviewed; we thus present our multi-institution experience of pediatric PCNL.
METHODS:
We reviewed all PCNLs performed on children at our institutions between 2005 and 2012. Data abstracted include patient age, operative time, stone weight and composition, service obtaining percutaneous renal access (urologist or radiologist), total fluoroscopy time, need for transfusion, and stone-free status following PCNL.
RESULTS:
Eight patients with mean age 10.5 years underwent PCNL. Mean stone weight obtained was 915 mg. Four were cystine, 2 brushite, 1 each calcium oxalate and struvite. Access was performed by urology in 6 and radiology in 2 (aborted in1). Mean fluoroscopy time was significantly shorter in the urology access group (166 vs 1167 seconds, p<0.0001). No patients were transfused. Of collecting systems accessed, 100% were rendered stone free in a mean of 1.15 procedures). No patients required transfusions.
CONCLUSIONS:
PCNL is a safe and effective treatment for large renal stones. Average fluoroscopy time with urologist-obtained access was significantly less, minimizing radiation exposure to the patient. High rate of underlying metabolic stone disease in children with large stones underscores the need for a comprehensive approach to their stone management.


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