Percutaneous nephrolithotomy in pediatric patients: is computerized tomography a must?

Abstract

The aim of this study was to retrospectively evaluate the results of pediatric percutaneous nephrolithotomy (PNL) cases, and discuss the results and necessity of non-contrast computerized tomography (CT) in these cases. In all, 48 pediatric patients who underwent PNL were retrospectively evaluated. Before PNL, either intravenous urography or CT was performed. In all patients, we evaluated the PNL time, scopy time with stone burden, and complications. During the PNL procedure, we switched to open surgery in two cases: in one because of renal pelvis perforation and in the other because of transcolonic access. In one patient who was scheduled to undergo PNL, we performed open surgery, primarily because we detected a retrorenal colon with CT. The stone burden in 45 patients who underwent PNL was 445 ± 225 mm(2), the PNL time was 51 ± 23 min, and the scopy time was 6.1 ± 2.7 min. We removed nephrostomy tubes 1-4 days after the procedure. In two patients, 24 h after removal of nephrostomy tubes, we inserted double J stents because of prolonged urine extravasation from the tract. In all, 34 of the 45 patients were stone-free, 5 patients had clinically insignificant stone fragments, and 6 patients had residual stones. PNL is a safe and effective method in the treatment of pediatric patients with kidney stones. Clinical experience is the most important factor in obtaining stone-free results. CT should be performed in all pediatric patients in order to prevent colon perforation.

Does previous open renal surgery or percutaneous nephrolithotomy affect the outcomes and complications of percutaneous nephrolithotomy

“…Some authors believed that bowel displacement after open surgery lead high risk for colonic perforation [18,22]. In order to prevent that desirable situation, Gedik et al recommended routine tomography in all patients with history of open renal surgery [29]. Differently, to decrease radiation exposure of CT scan, Kurtulus et al performed ultrasonography in patients [22].…”

Colon perforation during percutaneous renal surgery: a 10-year experience in a single endourology centre

“…However, as Tuttle et al [19] demonstrated the risk of colon injury is overestimated by evaluation of axial CT images alone compared with oblique parasagittal reformations. Recently, Gedik et al [20] suggested that CT should be performed in all paediatric patients prior to PCNL in order to prevent colon perforation. In case of trans-colonic access, they converted to open surgery.…”

The effects of previous open renal stone surgery types on PNL outcomes

“…14 Gedik et al instead recommended abdominal CT to identify colon disposition and to avoid colonic injury in PNL. 18 Our policy was to perform abdominal CT in patients with previous ORSS to assess colonic malposition, which may explain the absence of colonic injury in our study.…”