PCNL IN CHILDREN

There is a general belief that the pediatric population are less prone to stone formation as compared to adults. We used to see more of bladder stones in the pediatric age group .Many a times in the children the stones are attributed to the metabolic abnormality. Malnutrition( Protein Energy Malnutrition is the common cause for bladder stone formation in children).

 

The stones in pediatric age group are more and more seen in private urology set up. The kidney stones are also more often seen now-a-days. We have usually used ESWL as the treatment of choice in pediatric age group but certain things compel us for surgical intervention ( PCNL):

1) Bigger calculi

2) If the patient is from a far off place then repeated ESWL/STENTING and stent removals and follow-ups is impractical. In  such cases PCNL can be assorted to ...to make them stone free at once.

3) Upper calyceal calculi : ESWL can at times is risky because of lung injury( even after covering the lung fields with the polystyrene sheet) 

 

More often the urologists are compelled for PCNL for the want of ESWL machine.

With the advent of mini PERC, ultra- mini-PERC and Micro-PERC the PCNL has become less invasive and can be done in children with less blood loss and post -operative pain.We do routine Mini or Micro PERC in children( when it is required) .

 

MINI PERC BEING PERFORMED WITH 15 FR SHEATH AND MINI-NEPHROSCOPE

OUR PAEDIATRIC UROLOGIST DR VAMSHI DOING THE PCNL

Mini PERC :

 

 Stones in Miniature percutaneous (mini-perc) access was first described in the pediatric population by Jackman et al (1997) as an alternative to standard PCNL. Generally, it consists of downsizing to smaller percutaneous access sheaths with the intention of decreasing blood loss, postoperative pain, and the hospital stay in patients undergoing nephroscopic procedures.The access was done through posterior-inferior calyx. A J-tip PTFE guide wire was placed in the system.

 

Serial dilatation was done till 15 Fr and 15 Fr Sheath was introduced. The sheath has a offshoot Luer-Lock outflow for reduction of intra-pelvic pressure so as to reduce the incidence of sepsis.A wide angle straight forward telescope 12 ° with angled eyepiece (Karl Storz, Tuttingen, Germany) was used as nephrosocpe.Holmium LASER energy was used as energy for stone dis-integration.