Predicting surgical outcome of pediatric percutaneous nephrolithotomy

Abstract

Purpose: The aim was to evaluate the outcome of pediatric percutaneous nephrolithotomy (PCNL) guided by Guy’s stone score grading system.

Patients and methods: This was a prospective study of children with renal calculi more than 2 cm. They were younger than 18 years and were a candidate for PCNL at our University Hospitals from January 2013 until July 2016. All of them had a low-dose noncontrast enhanced computed tomography. The procedure was performed under general anesthesia with the patients in the prone position guided by fluoroscopy. The stone-free rate and the presence and type of complications were estimated. The demographic and clinical data, stone characteristics, radiologic anatomy as well the PCNL approach and methods of lithotripsy used were evaluated. Comparison was performed through using univariate and multivariate analyses, and factors predicting the PCNL outcome were determined.

Results: A total of 110 children with kidney stones were accepted for PCNL. Overall, 95 (86.3%) of 110 children were stone free after one-stage PCNL. Grade 1 Guy’s stone score was 97.5% (40/41) (P<0.05). Mean hospital stay was 4.01 ± 2.0 days. Operative complications include bleeding in 12 (10.9%), extravasation in seven (6.4%), injury to the colon in one (0.9%), and renal pelvis perforation three (2.7%). In our study, larger Amplatz sheath, stone burden, and longer operative time are related to complications.

Conclusion: Guy’s stone score correlated with both success and complications and can be used for decision making preoperatively in pediatric PCNL.

Keywords: Guy’s stone score, minimally invasive, percutaneous nephrolithotomy, pediatric, urolithiasis