Percutaneous Nephrolithotomy (PCNL) for Kidney Stones in Children

In this video:
[0:04] Callen’s kidney stone diagnosis
[0:30] Common symptoms of pediatric kidney stones
[1:08] Coming to CHOP for a second opinion
[1:40] Importance of partnering with patients and caregivers
[1:55] What is a horseshoe kidney?
[2:45] Treatment options for kidney stone removal
[3:07] What is percutaneous nephrolithotomy (PCNL)?
[4:00] Callen’s experience with PCNL

In this video, Kayla and Chris discuss their 6-year-old son Callen’s experience with kidney stones and what it was like to undergo the percutaneous nephrolithotomy (PCNL) procedure at Children’s Hospital of Philadelphia (CHOP).

Normally, urine contains many dissolved materials. If these materials become concentrated in the urine, they can form solid crystals that can lead to the development of small, hard deposits of minerals (called kidney stones) that can form inside the kidneys or ureter (the tube that connects the kidney to the bladder).

Kidney stone disease (also called nephrolithiasis) can have a tremendous impact on quality of life. It can cause blood in the urine, pain, nausea, vomiting and fever and block the drainage of urine. Kidney stones are associated with a higher risk of high blood pressure, heart disease, loss of kidney function, and lower bone mineral density leading to fractures.

Unfortunately, kidney stones are becoming more common in children. The likelihood that a child will develop a kidney stone has doubled over the last 25 years. Until recently, children with kidney stones were primarily treated in adult healthcare settings. Studies have shown, however, that specialized care for children with stones improves patient outcomes.

In 2014, to meet the rising need for specialized kidney stone treatment for children, Children’s Hospital of Philadelphia (CHOP) established the Pediatric Kidney Stone Center. The center offers integrated, state-of-the-art care for infants, children, adolescents, and young adults with kidney stone disease.

The center uses a multidisciplinary approach that includes care from pediatric urologists, pediatric nephrologists, radiologists, interventional radiologists, emergency room physicians, nurse practitioners, physician's assistants, nurses, and dietitians.

Today, children and adolescents from across the United States and world travel to CHOP's Pediatric Kidney Stone Center for care.

The Pediatric Kidney Stone Center offers three treatment options to remove pediatric kidney stones: lithotripsy, ureteroscopy and percutaneous nephrolithotomy (PCNL). This video takes an in-depth look at the percutaneous nephrolithotomy (PCNL) procedure, including a detailed account from Kayla and Chris about their 6-year-old son Callen’s experience with the procedure, and expert insight from expert pediatric urologist Gregory Tasian, MD, co-director of the center.

Percutaneous nephrolithotomy or PCNL is a minimally invasive inpatient procedure performed under general anesthesia to remove kidney stones. For the PCNL procedure, a small incision is made in the flank or back right side, underneath the rib cage. Through that incision, the urology surgeon uses large scopes to go directly into the kidney, locate the stone or stones, and then break them up with either a laser or an ultrasound device.

After a PCNL, usually a temporary device for urinary drainage is needed, whether a stent or a nephrostomy tube, that directly drains urine from the kidney.

The PCNL procedure is typically done with a short inpatient stay of one to a few days, during which time the patient is monitored for any signs of fever which can occur if the stone is due to infection. The nephrostomy tube is removed a few days after the procedure, once the patient has recovered.

Callen has a type of kidney called a "horseshoe kidney," in which the lower parts of his two kidneys are joined together to create a horseshoe shape. This configuration can make surgery challenging.

It is fairly common for PCNL to be used as a second-line surgery in situations like Callen’s, when a previous surgery — either ureteroscopy or lithotripsy — was not effective in removing a stone. One reason is that it provides the most direct access to the kidney.

The team at CHOP’s Kidney Stone Center believes in partnering with patients and their caregivers to determine which surgery is best. The team explains the treatment options and then partners with families to help them make the most informed decision possible.

The center team is involved in research dedicated to better understanding why kidney stones are occurring earlier in life and the factors that lead to kidney stones in children.

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[janeen]

Awwww little buddy. I to suffer with kidney stones. Started in my early 20s and I recently had another almost a year ago. This time 4 stones that was stubborn. I'm now seeing a kidney specialist from university of Penn. Hopefully she can help me and put me on a diet that will lesson the chances of more stones. 🙂

[derrickstinnett]

Can you do this procedure instead of a ureteroscopy on say a 5mm stone? I have had it for almost 2 months now

[irshadturk]

Mere 9 month baby ke both kidney me stone he
0.5 cm😢