Summary
Introduction
Percutaneous nephrolithotomy (PCNL) is one of the main approaches for the treatment
of large and complex stones in pediatric patients. The patient position for PCNL has
been classically divided into prone or supine and the prone position is more commonly
used. One of the most feared complications of this surgical technique is colon injury
and the objective of this work is to evaluate the incidence of retrorenal colon (RRC)
both supine and prone position, in pediatric patients, through radiological images.
Materials and method
A retrosepctive review was performed of all abdominal CT scans performed in one center,
in patients under 18 years since 2017 to 2019. The ideal path for percutaneous puncture
was traced in the upper, middle, and lower calyces of both kidneys in the prone and
supine positions and contact with the kidney and adjacent organs was evaluated, with
a uro-radiologist. Chi-square test and Student's t test were applied.
Results
50 CT-scans were performed on 44 children. Patients had a mean age of 12.6 years and
71.4% were male. Twenty-five scans were performed in the prone and 25 in the supine
position. The incidence of RRC for the left kidney (LK) was significantly higher in
the lower calyx in prone position than in the supine position, 28% vs 4% (p = 0.049),
and the right kidney (RK) presented RRC only in the prone position. The liver was
the most frequent retrorenal organ (97.7%) for the RK, with a non-significant difference
by position, while for the LK the spleen was the most frequent (61.1%).
Discussion
Colon injury is one of the most morbid complication in PCNL and one of the reasons
to perform a CT scan before surgery, on which its incidence appears to be <1% in adults.
The present study revealed RRC to be present in three (12%) patients in the supine
position and seven (28%) patients in the prone position (p=0.15). These results were slightly higher from those reported in adults (supine: 1.7%–10%;
prone: 6.8%–20%), but there are no reports in the literature on this issue to allow
appropriate comparison. This is the first study to attempt to assess the incidence
of RRC in children according to position.
Conclusion
Graphical AbstractIncidence of colon injury.
Keywords
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Article info
Publication history
Published online: August 02, 2022
Accepted:
July 27,
2022
Received in revised form:
July 26,
2022
Received:
December 30,
2021
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
