INTRODUCTION AND OBJECTIVES: The treatment of children with complex urolithiasis in anomalous kidneys is challenging. We report percutaneous nephrolithotomy (PCNL) for the management of stones in anomalous kidneys in children.

METHODS: We performed PCNL on 6 children (one with bilateral stones), 3 boys and 3 girls with anomalous kidneys. Two had horse shoe kidneys, 3 malrotated kidneys, and one crossed fussed ectopic kidney. Their age ranged from 5-12 years with a mean of 7.4±3.36 years. Two patients had previous failed ESWL, 4 underwent PCNL for large stone burden. Mean stone burden was 323±214 mm2 .Under fluoroscopic guidance we performed serial dilatation using Alken metal dilators. In 4 patients 17 Fr rigid nephroscope was used, in 2 patients 26 Fr nephroscope was utilized. Pneumatic lithotripsy was used for stone disintegration and forceps for stone extraction.

RESULTS: A single stage PCNL resulted in complete stone clearance in 5 children, while one required a second look procedure .Operative time ranged from 25-70 minutes with a mean of 43.33± 17.8 minutes.. None of the patients required blood transfusion .Perforation of the renal pelvis occurred in one patient and was managed by prolong insertion of nephrostomy tube .Hospital stay ranged from 1-6 days with a mean of 3 ± 2.8 days .Posoperative fever occurred in one child and persisted for 3 days. All children were followed for 3 months and were stone free. Patient with bilateral stones performed ESWL on the contra lateral side.

CONCLUSIONS: Children with stones in anomalous kidneys can be managed safely with PCNL when they are properly selected

Source of Funding: none