Impact of Previous Stone Treatment on the Outcomes of Percutaneous Nephrolithotomy in Children with Renal Stones

Abstract

Objective: In this single center study, we aimed to compare perioperative outcomes of PCNL in pediatric patients with and without history of previous stone treatments including open renal stone surgery, PCNL, and shockwave lithotripsy (SWL).

Material and Methods: We retrospectively evaluated children under 18 years of age who underwent PCNL operation between 2008 and 2016 in our clinic. Cases were further divided into two groups: patients with a history of open renal surgery or PCNL or failed SWL on the same side were categorized as group 1, primary PCNL patients were categorized as group 2. Demographic data, preoperative and operative data were compared between the selected two groups. We used kidney-ureter-bladder radiography (non-contrast-enhanced computed tomography in cases with non-opaque stones) that performed 6 weeks postoperatively for the assessment of residual stones (≥4mm). Postoperative complications were recorded according to modified Clavien classification. Residual stone rates and complications of PCNL were compared between the two groups.

Results: The study included 122 PCNL cases with mean±SD age of 7.14±4.86 years. 35 of the 122 PNL cases (28.69%) had a history of previous stone treatment for the same side kidney stone. There was no statistically significant difference between the two groups in terms of change in hemoglobin values (p=0.997), operation time (p=0.584) and hospital stay (p=0.997). No statistically significant difference was found the residual stone rates (p=0.365) and postoperative com- plications (p=0.886), as well. No statistically significant differences were found between the groups for the rates of residual stones (p=0.365) and postoperative complications (p=0.886), as well.

Conclusion: The results of this study demonstrate that PCNL can be safely performed in children with previous stone treatment. 

Keywords

• kidney stone
• pediatrics
• Nephrolithotomy
• Percutaneous

Böbrek Taşı Olan Çocuklarda Önceki Taş Tedavisinin Perkütan Nefrolitotomi Sonuçlarına Etkisi

Abstract

Amaç: Biz bu tek merkezli çalışmada, daha önce aynı taraf şok dalga litotripsi (SWL), perkütan nefrolitotomi (PNL) veya açık böbrek taş cerrahisi olan ve olmayan çocuk hastalarda uyguladığımız PNL ope- rasyonlarının perioperatif sonuçlarını karşılaştırmayı amaçladık.

Gereç ve Yöntemler: 2008–2016 tarihleri arasında kliniğimizde PNL operasyonu uygulanmış 18 yaş altı çocukların verileri retrospektif olarak değerlendirildi. Olgular, böbrek taşı tanısı ile daha önce aynı taraf SWL, PNL veya açık cerrahiyi içeren taş tedavisi öyküsü olanlar (grup 1) ve olmayanlar (grup 2) olarak iki gruba ayrıldı. Demografik veriler ile preoperatif ve operatif veriler belirlenen gruplar arasında karşılaştırıldı. Postoperatif 6. haftada çekilen direkt üriner sistem grafisinde (radyolüsent taşlarda kontrastsız bilgisayarlı tomografide) 4 mm ve üzeri taşlar rezidüel taş olarak kabul edildi. Postoperatif komplikasyonlar modifiye Clavien sınıflamasına göre kaydedildi. PNL sonrası rezidüel taş varlığı ve komplikasyonlar iki grup arasında karşılaştırıldı.

Bulgular: Çalışmaya alınan toplamda 122 çocuk PNL olgusunun ortalama yaşı (mean±SD) 7.14±4.86 olarak saptandı. 122 PNL olgusunun 35’inde (%28.69) aynı taraf böbrek taşına yönelik tedavi öyküsü vardı. Hemoglobin değerlerinde değişim (p=0.997), operasyon (p=0.584) ve hastanede kalış (p=0.997) süresi açısından iki grup arasında istatistiksel olarak anlamlı fark yoktu. Gruplar arasında karşılaştırılan rezidüel taş (p=0.365) ve postoperatif komplikasyon (p=0.886) oranları arasında da istatiksel anlamlı fark saptanmadı.

Sonuç: Bu çalışmanın sonuçları, PNL’nin böbrek taşı tedavisi geçirmiş çocuk hastalarda güvenli bir şekilde uygulanabileceğini ortaya koymaktadır. 

Keywords

• Böbrek taşı
• Perkütan nefrolitotomi
• pediatri

References

1. 1. Geraghty RM, Jones P, Somani BK. Worldwide Trends of Urinary Stone Disease Treatment Over the Last Two Deca- des: A Systematic Review. J Endourol 2017; 31:547-56.
2. 2. Pietropaolo A, Proietti S, Jones P, et al. Trends of interven- tion for paediatric stone disease over the last two decades (2000-2015): A systematic review of literature. Arab J Urol 2017; 15:306-11.
3. 3. Hu H, Lu Y, Cui L, et al. Impact of previous open renal sur- gery on the outcomes of subsequent percutaneous nephrolit- hotomy: a meta-analysis. BMJ Open 2016; 6:e010627.
4. 4. Onal B, Gevher F, Argun B, et al. Does previous open neph- rolithotomy affect the outcomes and complications of percu- taneous nephrolithotomy in children? J Pediatr Urol 2014; 10:730-6.
5. 5. Aldaqadossi HA, Kotb Y, Mohi K. Efficacy and safety of per- cutaneous nephrolithotomy in children with previous renal stone operations. J Endourol 2015; 29:878-82.
6. 6. Telli O, Haciyev P, Karimov S, et al. Does previous stone tre- atment in children generate a disadvantage or just the oppo- site? Urolithiasis 2015; 43:141–5.
7. 7. Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: introduction to the system used by the Soci- ety for Fetal Urology. Pediatr Radiol 1993; 23:478-80.
8. 8. de la Rosette JJ, Opondo D, Daels FP, et al. Categorisation of complications and validation of the Clavien score for percu- taneous nephrolithotomy. Eur Urol 2012; 62:246-55.

9. 9. Khorrami M, Hadi M, Sichani MM, et al. Percutaneous nephrolithotomy success rate and complications in patients with previous open stone surgery. Urol J 2014; 11:1557-62.
10. 10. Tugcu V, Su FE, Kalfazade N, et al. Percutaneous nephrolit- hotomy (PCNL) in patients with previous open stone sur- gery. Int Urol Nephrol 2008; 40:881-4.
11. 11. Margel D, Lifshitz DA, Kugel V, et al. Percutaneous nephro- lithotomy in patients who previously underwent open neph- rolithotomy. J Endourol 2005; 19:1161-4.
12. 12. Gupta R, Gupta A, Singh G, et al. PCNL—a comparati- ve study in nonoperated and in previously operated (open nephrolithotomy/ pyelolithotomy) patients—a single-surge- on experience. Int Braz J Urol 2011; 37:739-44.
13. 13. Falahatkar S, Panahandeh Z, Ashoori E, et al. What is the dif- ference between percutaneous nephrolithotomy in patients with and without previous open renal surgery? J Endourol 2009; 23:1107-10.
14. 14. Gupta NP, Mishra S, Nayyar R, et al. Comparative analysis of percutaneous nephrolithotomy in patients with and without a history of open stone surgery: single center experience. J Endourol 2009; 23:913-16.
15. 15. Kurtulus FO, Fazlioglu A, Tandogdu Z, et al. Percutaneous nephrolithotomy: primary patients versus patients with his- tory of open renal surgery. J Endourol 2008; 22:2671-5.
16. 16. Sofikerim M, Demirci D, Gülmez I, et al. Does previous open nephrolithotomy affect the outcome of percutaneous neph- rolithotomy? J Endourol 2007; 21:401-3.
17. 17. Lojanapiwat B. Previous open nephrolithotomy: does it af- fect percutaneous nephrolithotomy techniques and outco- me. J Endourol 2006; 20:17-20.
18. 18. Basiri A, Karrami H, Moghaddam SMH, et al. Percutaneo- us nephrolithotomy in patients with or without a history of open nephrolithotomy. J Endourol 2003; 17:213-16.
19. 19. Netto Junior N, Lemos GC, Fiuza JL. Percutaneous nephro- lithotomy in patients with previous renal surgery. Eur Urol 1988; 14:353-5.
20. 20. Yesil S, Ozturk U, Goktug HN, et al. Previous open renal sur- gery increased vascular complications in percutaneous neph- rolithotomy (PCNL) compared with primary and secondary PCNL and extracorporeal shock wave lithotripsy patients: a retrospective study. Urol Int 2013; 91:331-4.
21. 21. Ozgor F, Kucuktopcu O, Sarılar O, et al. Does previous open renal surgery or percutaneous nephrolithotomy affect the outcomes and complications of percutaneous nephrolitho- tomy. Urolithiasis 2015; 43:541-7.
22. 22. McAteer JA, Evan AP. The acute and long-term adverse ef- fects of shock wave lithotripsy. Semin Nephrol 2008; 28:200– 13.
23. 23. Willis LR, Evan AP, Connors BA, et al. Shockwave lithot- ripsy: dose-related effects on renal structure, hemodynamics, and tubular function. J Endourol 2005; 19:90-101.
24. 24. Handa RK, Evan AP. A chronic outcome of shock wave lit- hotripsy is parenchymal fibrosis. Urol Res 2010; 38:301-5.
25. 25. Türk H, Yoldaş M, Süelözgen T, et al. Effects of previous un- successful extracorporeal shockwave lithotripsy treatment on the performance and outcome of percutaneous nephrolitho- tomy. Arab J Urol 2017; 15:94-9.
26. 26. Resorlu B, Kara C, Senocak C, Cicekbilek I, Unsal A. Effect of previous open renal surgery and failed extracorporeal shock- wave lithotripsy on the performance and outcomes of percu- taneous nephrolithotomy. J Endourol 2010; 24:13-6.
27. 27. Yuruk E, Tefekli A, Sari E et al. Does previous extracorporeal shock wave lithotripsy affect the performance and outcome of percutaneous nephrolithotomy? J Urol 2009; 181:663-7.
28. 28. Bon D, Dore ́ B, Fournier F et al (1993) Percutneous neph- rolithotomy after failure of extracorporeal shockwave lit- hotripsy. Indications, results, perspectives. Prog Urol 1993; 3:951-8.
29. 29. Reddy SV, Shaik AB. Outcome and complications of percu- taneous nephrolithotomy as primary versus secondary pro- cedure for renal calculi. Int Braz J Urol 2016; 42:262-9.