UroToday- This study from Pakistan had 56 children who underwent a total of 60 PCNL's between January 2000 and December 2004. These children were studied prospectively. All children had a DMSA scan done postoperatively. The children were stratified by demographics, stone size, location of the stones and outcomes delineated by clearance of these stones with PCNL alone or needing additional procedures including shock wave lithotripsy. The group prospectively looked for the presence of focal renal damage after PCNL treatment due to the tracts.

The group found that out of the 60 renal units, cortical defects on DMSA scan were seen in 10 kidneys (17 %.) In only 3 of these kidneys, did the site of the focal defect correspond to the access site for the tract formation during PCNL? There were 2 other kidneys that had scarring at multiple sites, but only 1 of these sites corresponded to the access during PCNL. In the remaining 5 kidneys, there was no association between the renal damage seen on DMSA scan and the nephrostomy tract. There was also no correlation between the size of the nephroscope used and the renal damage.

The group concluded that there is a 5% risk of focal damage after percutaneous nephrostomy. They agreed that this may be an over estimate since preoperative DMSA scans were not done on these patients. I feel not having preoperative DMSA scans makes this study difficult to interpret. The study would have a large impact if we had preoperative DMSA scans as well as a long term follow-up of these children to assess how many are truly left with permanent renal scarring after percutaneous nephrostolithotomy.

Lubna Samad, Samia Qureshi, Zafar Zaidi

Journal of Pediatric Urology. 3(1): 36-39, February 2007
Reviewed by UroToday Contributing Editor Pasquale Casale, MD

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