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PRESENTATIONPercutaneous nephrolithotripsy (PCNL) in children:Experience of Parma.Antonio Frattini 1 , Stefania Ferretti 1 , Antonio Salvaggio 21 O.U. Urology, Azienda Ospedaliero-Universitaria of Parma, Italy;2 O.U. Urology, Ospedale Sacco, Milano, ItalySummary19 Percutaneous nephrolithotripsy procedures were done in 15 children aged from 8months to 16 years with complex renal stones and/or extracorporeal shock wavelithotripsy refractory stones. The percutaneous techniques were done with the instrumentand position (prone and supine) used in adults. 14/15 patients were stone-free(13 pts in one time, 1 pt in 2 procedures and 1 pt, with complex bilateral stones disease,in 5 endourological sessions). No relevant complications developed: 1 patient need a bloodtransfusion and 1 a temporary indwelling catheter for colic pain due to oedema. We believe thatin children the endourological approach is better than traditional open surgery or reiteratedextracorporeal shock wave lithotripsy sessions which often need anaesthesia and can not guaranteea complete clearance of the stones.KEY WORDS: Percutaneous nephrolithotripsy; Children; Supine position.Submitted 9 May 2009; Accepted 30 June 2009INTRODUCTIONPaediatric percutaneous nephrolithotripsy is a not frequentprocedure due to the low incidence of stone diseasein this age, but the endourological procedure(ureterolithotripsy/percutaneous approach) are consideredas the first choice for several stone diseases whenESWL is not effective or contraindicated, bearing alsoin mind that these patients are exposed to an high incidenceof lithiasic recurrences and surgical treatments.Nowadays, the improvement of mini-instruments andnew lithotripsy sources (e.g. LASER) allows a less invasiveprocedure, less X-ray exposure with an excellentstone-free rate patients.We report our experience on percutaneous procedures inpaediatric age.1 had a complete duplicity of the upper urinary tract; 1had an horsekidney, 1 was affected by spinal cord diseaseand had been previously operated of enterocistoplastyand bilateral ureteral reimplantations; 1 presented withnephrocalcinosis (Fanconi’s syndrome); and 2 cases afterunsuccessful extracorporeal renal lithotripsy.In 10 procedures a 14 Fr renal access was performed,in 7 cases a 20 Fr and in 2 cases a 30 Fr, respectively. Thefirst 10 percutaneous approaches were performed inprone position, subsequently we changed our percutaneoussurgical standard (4/2004) using the supine position(9), both in adult and children. In children olderthan 2 years the supine percutaneous position allows frequentlythe contemporaneous use of flexible uretheroscopy(positioning as first step) for the selection ofMATERIAL AND METHODSFrom 2001 to June 2008, we performed 19percutaneous approaches in 15 pts (10female and 5 male); age-range: 8 months-16 years, with a mean age of 8,3 ± 4,9 yrs.The mean stone burden was 31 ± 10,3 mm(range: 18-45 mm) (Table 1). Two patientspresented with bilateral complex lithiasis;Table 1.Stone Distribution.Complex Lithiasis (2) Single Lithiasis (6) Multiple Lithiasis (7)2 Pielic (4) Pielic/Calix (4)(1 bilateral) UPJ (2) Pielic/Calix/Ureteral (3)Archivio Italiano di Urologia e Andrologia 2010; 82, 151