Department of Urology, University Hospital of Parma/Azienda Ospedaliero, Universitaria Di Parma, Via Gramsci 14, 43126, Parma, Italy.
Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
Int Urol Nephrol. 2022 Dec;54(12):3063-3068. doi: 10.1007/s11255-022-03341-y. Epub 2022 Aug 13.
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.
We retrospectively reviewed two centers' experience in prone and supine PNL in children to analyze its results and complications.
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.
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.
儿童时期的结石病是一个日益严重的问题。经皮肾镜碎石术（PNL）可用于治疗较大和复杂的结石。与成人一样，它可以在仰卧位或俯卧位进行。
我们回顾了两个中心在儿童中俯卧位和仰卧位 PNL 的经验，以分析其结果和并发症。
33 例患者接受了俯卧位和 19 例仰卧位手术。俯卧位组的患者比仰卧位组年轻，但结石负荷、通道大小、手术时间或并发症无显著差异。并发症为：俯卧位组 8 例（Clavien 1 级），仰卧位组 4 例（Clavien 1 级），俯卧位组 1 例尿脓毒症（Clavien 4b 级），仰卧位组 2 例 Clavien 3 级（因肾绞痛放置双 J 支架和因石街行输尿管镜检查）。无管化手术和平均肾造口时间有利于仰卧位组，而透视时间和输尿管引流时间则支持俯卧位组。仰卧位组的结石清除率更高（83.3%比 66.6%），这可能反映了在 12 例患者中可以同时进行顺行和逆行联合入路（允许同时到达所有肾盏）的能力，或者俯卧位组患者年龄更小（13 例比 2 例患者≤5 岁），但结石负荷无差异。
仰卧位方法似乎可以保证更高的结石清除率。需要更大的系列来确定在 X 射线暴露、手术时间和并发症方面哪种技术最好。
