Davide Campobasso1, Tommaso Bocchialini2, Luigi Bevilacqua3, Giulio Guarino2,3, Corradino Di Pietro3, Pietro Granelli2,4, Davide Mezzogori5, Paolo Salsi2,4, Pietro Oltolina3, Claudia Gatti6, Stefano Puliatti3, Pier Luca Ceccarelli7, Umberto Maestroni2, Antonio Frattini8, Giampaolo Bianchi3, Salvatore Micali3, Stefania Ferretti2,4. 1. Department of Urology, University Hospital of Parma/Azienda Ospedaliero, Universitaria Di Parma, Via Gramsci 14, 43126, Parma, Italy. d.campobasso@virgilio.it. 2. Department of Urology, University Hospital of Parma/Azienda Ospedaliero, Universitaria Di Parma, Via Gramsci 14, 43126, Parma, Italy. 3. Department of Urology, University of Modena and Reggio Emilia, Modena, Italy. 4. SS Endourology and Less Invasive Percutaneous Surgery, University Hospital of Parma, Urology OU, Parma, Italy. 5. Department of Engineering and Architecture, University of Parma, Parma, Italy. 6. Paediatric Surgery Unit, University Hospital of Parma, Parma, Italy. 7. Pediatric Surgical Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy. 8. Urology Unit, Civil Hospital of Guastalla, Azienda USL-IRCCS di Reggio Emilia, Guastalla, Italy.
Abstract
PURPOSE: Stone disease in the pediatric age is an increasing issue. Percutaneous Nephrolithotomy (PNL) can be used for larger and complex stones. As in adults it can be performed in the supine or prone position. METHODS: We retrospectively reviewed two centers' experience in prone and supine PNL in children to analyze its results and complications. RESULTS: 33 patients underwent prone and 19 supine procedures. Patients in the prone group were younger than in the supine, while no significant differences were found in stone burden, access size, operative time or complications. Complications were: 8 and 4 Clavien 1 for the prone and supine group, respectively, one case of urosepsis (4b) in the prone and 2 cases of Clavien 3 in the supine group (double J stent placement for renal colic and ureteroscopy for steinstrasse). Tubeless procedures and mean nephrostomy time were in favor of the supine group, whereas fluoroscopy time and ureteral drainage stay were in support of the prone group. Stone free rate was better in the supine group (83.3 vs 66.6%), possibly reflecting the capability to perform a combined approach in 12 patients (allowing to reach all the calyx with simultaneous anterograde and retrograde access) or younger age in the prone group (13 vs 2 patients ≤5 years), with no differences in stone burden. CONCLUSIONS: Supine approach seems to guarantee higher stone-free rates. Larger series are necessary to determine what the best technique is in terms of X-ray exposure, operative time and complications.
PURPOSE: Stone disease in the pediatric age is an increasing issue. Percutaneous Nephrolithotomy (PNL) can be used for larger and complex stones. As in adults it can be performed in the supine or prone position. METHODS: We retrospectively reviewed two centers' experience in prone and supine PNL in children to analyze its results and complications. RESULTS: 33 patients underwent prone and 19 supine procedures. Patients in the prone group were younger than in the supine, while no significant differences were found in stone burden, access size, operative time or complications. Complications were: 8 and 4 Clavien 1 for the prone and supine group, respectively, one case of urosepsis (4b) in the prone and 2 cases of Clavien 3 in the supine group (double J stent placement for renal colic and ureteroscopy for steinstrasse). Tubeless procedures and mean nephrostomy time were in favor of the supine group, whereas fluoroscopy time and ureteral drainage stay were in support of the prone group. Stone free rate was better in the supine group (83.3 vs 66.6%), possibly reflecting the capability to perform a combined approach in 12 patients (allowing to reach all the calyx with simultaneous anterograde and retrograde access) or younger age in the prone group (13 vs 2 patients ≤5 years), with no differences in stone burden. CONCLUSIONS: Supine approach seems to guarantee higher stone-free rates. Larger series are necessary to determine what the best technique is in terms of X-ray exposure, operative time and complications.