Ambulatory percutaneous nephrolithotomy in a pediatric patient: case report

Ambulatory percutaneous nephrolithotomy in a pediatric patient: case report

Julio C. Boada 1 , Sebastian Peña 2 , Adolfo Serrano 2 , Cristina Domínguez 2

1 Facultad de Medicina, Universidad de los Andes, Bogotá D.C, Colombia; 2 Departamento de Urología, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá D.C, Colombia

*Correspondence: Cristina Domínguez. Email: invest.urologia@fsfb.org.co

Abstract

Percutaneous nephrolithotomy (PNL) is the first-line treatment for staghorn stones or those larger than 20 mm. Although ambulatory PNL has been established as a cost-effective alternative in adults, with no increase in complications, evidence in the pediatric population remains scarce. This report presents the first documented case of ambulatory PNL in a pediatric patient, assessing its feasibility and safety. A systematic review of the literature was conducted using databases such as PubMed, Embase, and Science Direct to support the analysis of the clinical case. The patient, diagnosed with an 18 mm staghorn stone in the left kidney without obstruction, underwent outpatient PNL, including stone fragmentation and extraction. Stone composition analysis revealed 70% ammonium magnesium phosphate (struvite) and 30% carbonate apatite. The patient was discharged on the same day and monitored through telemedicine. No complications or readmissions occurred. This case demonstrates that outpatient PNL is a feasible and safe option for select pediatric patients, provided adequate follow-up is ensured. However, further studies are necessary to identify the critical factors for safely expanding this practice in the pediatric population without increasing the risk of complications.

Keywords: Percutaneous nephrolithotomy. Staghorn nephrolithiasis. Pediatrics. Teleconsultation. Ambulatory management.

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