Which factors affect the success of pediatric PCNL? Single center experience over 20 years


Submitted: May 24, 2020
Accepted: July 30, 2020
Published: December 18, 2020
Abstract Views: 855
PDF: 433
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Authors

  • Volkan Izol Department of Urology, Faculty of Medicine, University of Çukurova, Adana, Turkey.
  • Nihat Satar Department of Urology, Faculty of Medicine, University of Çukurova, Adana, Turkey.
  • Yıldırım Bayazit Department of Urology, Faculty of Medicine, University of Çukurova, Adana, Turkey.
  • Fatih Gokalp Clinic of Urology, Osmaniye Government Hospital, Osmaniye, Turkey.
  • Nebil Akdogan Department of Urology, Faculty of Medicine, University of Çukurova, Adana, Turkey.
  • Ibrahim Atilla Aridogan Department of Urology, Faculty of Medicine, University of Çukurova, Adana, Turkey.

Objective: We aimed to investigate the impact of surgeons’ experience on pediatric percutaneous nephrolithotomy (PCNL) outcomes. Materials and methods: Between June 1997 and June 2018, 573 pediatric patients with 654 renal units underwent PCNL for renal stone disease by senior surgeons. Data were divided into two groups, group-1 (n = 267), first ten years period, group-2 (n = 387); second ten years period. Results: Mean ± SD age of patients was 7.6 ± 4.9 (1-17) years. The stone-free rates (SFR) assessed after 4 weeks were 74.9% vs. 83.4% in group-1 vs. group-2, respectively (p = 0.03). The mean operation time, fluoroscopy time, and the number of patients requiring blood transfusion significantly decreased in group 2 (100.4 ± 57.5 vs. 63.63 ± 36.3, 12.1 ± 8.3 vs. 8.3 ± 5.4, and 24.3% vs. 2.9%; p < 0.001, p < 0.001, and p = 0.002 in group-1 versus group-2, respectively). On multivariate analysis, increasing stone size increased operation time (p < 0.001), fluoroscopy time (p < 0.001), intraoperative and postoperative blood transfusion rates (p = 0.006 and p = 0.018, respectively), and hospital stay (p = 0.002) but was not associated with change of glomerular filtration rate (GFR) (p = 0.71). Sheath size also correlated with increased fluoroscopy time (p < 0.001), operation time (p < 0.001), intraoperative blood transfusion (p < 0.001) and hospital stay, but sheath size did not affect postoperative blood transfusion (p = 0.614) or GFR change (p = 0.994). Conclusions: The percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure and is well accepted because of its lower complication rate and high efficiency for pediatric patients. Stone and sheath size are predictive factors for blood loss and hospital stay. During 20 years, our fluoroscopy time, operation time, blood loss, and complication rates decreased, and stone-free rate increased.


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Izol, V., Satar, N., Bayazit , Y., Gokalp, F., Akdogan, N., & Aridogan, I. A. (2020). Which factors affect the success of pediatric PCNL? Single center experience over 20 years. Archivio Italiano Di Urologia E Andrologia, 92(4). https://doi.org/10.4081/aiua.2020.4.345

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