Background and purpose: Treatment of children with staghorn and complex caliceal calculi is one of the most challenging problems in urology. We present our experience with percutaneous nephrolithotomy (PCNL) monotherapy for staghorn and complex caliceal calculi in children less than 5 years of age.
Patients and methods: Between 1991 and 2004, 27 boys and 9 girls aged 11 months to 4.5 years underwent PCNL for staghorn (33%) or complex caliceal (67%) calculi. The average bulk of the stones was 140.17 +/- 42.16 mm(2) (range 61-253 mm(2)). Staging of the procedure was preferred in children with renal insufficiency, urinary-tract infection, fragmentation time >60 minutes, or a stone burden requiring more than two tracts. Essential steps of the technique were a dynamic contrast study to select the appropriate-size Amplatz sheath and ultrasound guidance for renal access.
Results: The average operative time was 72.11 +/- 28.86 minutes. The stone-free rate was 86%, the mean hemoglobin drop was 2.2 +/- 0.95 g/dL, and the mean hospital stay was 3.5 days. Less than half of the patients (42%) were treated in a single stage, the remainder requiring multiple procedures. Only 39% could be treated with a single tract. There was statistically significant increase in the blood loss in patients requiring multiple tracts (P = 0.008); however, staging the procedure did not increase the blood loss (P = 0.06).
Conclusion: Percutaneous nephrolithotomy is safe and effective in children less than 5 years of age. Staging the procedure, instrument modification, the timed "multi mini-perc" technique, and ultrasound-guided access help in achieving maximum stone clearance with minimal morbidity.