Experience of percutaneous nephrolithotomy using adult-size instruments in children less than 5 years old

Objective: We present our experience with percutaneous nephrolithotomy (PCNL) for management of large renal calculi in children less than 5 years old, and determine its safety and efficacy when using an adult-size device. Patients and methods: Twenty patients younger than 5 years old underwent PCNL between August 2003 and July 2008. After retrograde catheterization, the nephrostomy tract dilated up to 26 Fr. Then a 24-Fr rigid nephroscope was used and stones were fragmented with a pneumatic lithotripter. Results: Twenty patients with a mean age of 3.1 years underwent 26 PCNL procedures on 24 renal units. Four patients had bilateral renal stones. Five patients (20%) had staghorn stones, as did five of the other cases with multiple stones. Four patients had undergone previous stone surgery on the same side. All of the patients were managed with only one tract. The mean stone size was 33 (20-46) mm and average operative time was 93.25 (78-174) min. Stones were completely cleared in 79.16% of patients, which increased to 91.67% with adjunctive shockwave lithotripsy. The overall complication rate was 15.38% and mean hospital stay was 5.26 (3-8) days. Conclusion: PCNL is an effective and safe treatment for renal calculi in children less than 5 years old, even when using instruments designed for adults. (C) 2009 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.