Efficacy and safety of percutaneous nephrolithotomy with adult standard size instruments in children under 3 years of age: a 10 years single-center experience

Background: Using percutaneous nephrolitotomy (PCNL) with large adult instruments in treatment of pediatricurolithiasis is still in debate. This study was conducted to evaluate the efficacy and safety of PCNL with adult's instrument in treatment of patients less than 3 years old. Methods: Data on patient characteristics and outcomes for 261 consecutive children undergoing PCNL at a Labbafinejad University Hospital were collected prospectively from September 2006 to February 2016. Thirty-two children, with 34 renal units, who were treated with PCNL were enrolled in the study. All PCNL procedures were performed via subcostal approach with one access tract in all of them. Postoperative complications were evaluated according to the modified Clavien grading system. Results: The mean age of patients was 19.4 +/- 6.2 months. Two patients had bilateral stones; thus, PCNL was performed on 34 kidney units. The mean size of the largest stone diameter was 17.5 +/- 7.8 mm. The mean duration of procedures was 121.52 +/- 29.05 minutes, ranging from 60 to 180 minutes. The most common complication was fever (n = 9, 26.4%), and hemorrhage that needs transfusion was the second one (n = 4, 11.7%). Seventeen patients with complications were in the first degree of Clavien complication system and five of them were in the second degree. Conclusions: Due to our experience, utilizing PCNL with adult-sized instruments in management of urolithiasis in less than 3 years old children appeared to be effective and relatively safe.