Predicting surgical outcome of pediatric percutaneous nephrolithotomy

Purpose: The aim was to evaluate the outcome of pediatric percutaneous nephrolithotomy (PCNL) guided by Guy’s stone score grading system.Patients and methods: This was a prospective study of children with renal calculi more than 2 cm. They were younger than 18 years and were a candidate for PCNL at our University Hospitals from January 2013 until July 2016. All of them had a low-dose noncontrast enhanced computed tomography. The procedure was performed under general anesthesia with the patients in the prone position guided by fluoroscopy. The stone-free rate and the presence and type of complications were estimated. The demographic and clinical data, stone characteristics, radiologic anatomy as well the PCNL approach and methods of lithotripsy used were evaluated. Comparison was performed through using univariate and multivariate analyses, and factors predicting the PCNL outcome were determined.Results: A total of 110 children with kidney stones were accepted for PCNL. Overall, 95 (86.3%) of 110 children were stone free after one-stage PCNL. Grade 1 Guy’s stone score was 97.5% (40/41) (P<0.05). Mean hospital stay was 4.01 ± 2.0 days. Operative complications include bleeding in 12 (10.9%), extravasation in seven (6.4%), injury to the colon in one (0.9%), and renal pelvis perforation three (2.7%). In our study, larger Amplatz sheath, stone burden, and longer operative time are related to complications.Conclusion: Guy’s stone score correlated with both success and complications and can be used for decision making preoperatively in pediatric PCNL.Keywords: Guy’s stone score, minimally invasive, percutaneous nephrolithotomy, pediatric, urolithiasi

Follow-up of 50 children after posterior urethral valve management in Al-Azhar University Hospitals

Objective: This study was performed to assess the various clinical presentations, complications, and surgical management, as well as follow-up, of patients with posterior urethral valve (PUV).Patients and methods: This is a prospective descriptive analysis of the data of 50 patients with PUVs of different age reviewed. Serum creatinine levels, clinical examination, abdominopelvic ultrasound, and magnetic resonance urography were performed, and the diagnosis was confirmedby voiding cystourethrography. The patients were divided into two categories: primary intervention and surgical intervention.Results: A total of 50 boys with a mean age at diagnosis of 100 ±15 days were included in this work. The most common presentation in patients managed by valve ablation was difficult micturition (60%), whereas in patients managed by initial vesicostomy the most common presentation was febrile urinary tract infection (67%). Vesicoureteral reflux presented in 61.2% and hydronephrosis in 82.6%, whereas complications occurred in three (6%) children. Mortality occurred in five (10%) patients. Postoperative improvement of hydronephrosis grade in both categories is not appreciably different.Conclusion: Urinary drainage using small catheters or nasogastric tube in the early days of infancy followed by valve ablation is the best treatment modality in PUV.Keywords: children, outcome, posterior urethral valve, urinary drainage valve ablation, vesicostom