Percutaneous nephrolithotomy in children

Tina K. Schuster, Marc C. Smaldone, Timothy D. Averch, Michael C. Ost

Research output: Contribution to journalReview articlepeer-review

36 Scopus citations

Abstract

Purpose: To review the history of percutaneous nephrolithotomy (PCNL) in children, describe technical considerations, including advancements in equipment, and discuss future directions. Materials and Methods: A comprehensive literature review was performed using MEDLINE/PubMed to evaluate the use of PCNL in the pediatric population, including historical background, indications, operative techniques, and outcomes. Results: PCNL was first applied to the pediatric population in the 1980s using adult-size instruments. Although there is still concern for potential renal damage in relatively small kidneys, initial investigations have demonstrated its safety and efficacy in children. Operative techniques are similar to those used in adult patients, but considerations specific to pediatric populations must be addressed. Modifications in technique including "mini-perc" access have reduced postoperative morbidity without an appreciable difference in outcomes. Technologic improvements, including miniaturization of endoscopes and advances in energy sources for stone fragmentation, have facilitated stone-free rates comparable to those of adult populations with PCNL monotherapy and sandwich shockwave lithotripsy therapy with minimal postoperative morbidity. Conclusions: Technologic advancements and refinements in technique have facilitated the successful application of PCNL in the pediatric population. As a result, PCNL has now replaced open surgery as the treatment of choice for large stone burdens in children of all ages.

Original languageEnglish
Pages (from-to)1699-1705
Number of pages7
JournalJournal of Endourology
Volume23
Issue number10
DOIs
StatePublished - Jan 10 2009
Externally publishedYes

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