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Percutaneous nephrolithotomy (PCNL) is already an established method of management of renal stone in Bangladesh. Initially the procedure was restricted to adult age group only. Percutaneous Nephrolithotomy is the choice of procedure for management of renal stone in paediatric age group. Objectives: To see the out come of stone clearance by Percutaneous Nephrolithotomy (PCNL)in paediatric age group Methods: This was a study in single centre since January' 09 to December 2011. Total 11 cases of renal stone in paediatric age group were managed by PCNL. The age ranges from 4 years to 15years, average 8.47 years. We use pneumatic lithotripters. Nephrostomy tubes and D-J stent were used in 7 cases. In 4 cases only DJ stent were used. Postoperative haematocrit and creatinine was measured routinely. Results: Total stone clearance was achieved in all cases. The major post-operative complication was urosepsis(n-1), managed conservatively. Total hospital stay was 3 to 5 · days; average 3.5 days. Stents were removed after 2 weeks. Conclusions: PCNL is a suitable procedure for the management of renal stone in pediatric age group. This needs expertise, longer learning curve under supervised training. Introduction Renal stone disease is not uncommon problem in Bangladesh. ESWL, PCNL, Open Surgery arethe modalities of stone management. The advantage of ESWL by Chaussy et al1 in 1982 has redefined the treatment of stone disease. Several reports have attested to its safety in pediatric populatiorr--". Safety of PCNL has also been established in this age group5·6. Methodology and type of equipment used differ. Here we express our experience and modification using the inner sheath of adult Storz Nephroscope and sometime 1 0Fr URS. This combines the advantage of safety and convenience of using adult size energy probes and instruments. Correspondence to: Dr. NI Bhuiyan, Assistant Professor of Urology, Bangladesh Medical College, Dhanmondi, Dhaka 1209, Bangladesh. E-mail:dmib@yahoo.com Tel: 008801713443393 Received: 04 September, 2012 Accepted: 08 January 2013 Materials and Method PCNL done in Pediatric patient (below 15 years) with renal stone admitted in the departmentof Urology Bangladesh Medical College Hospital from January' 09 to December 2011. Out come of PCNL analyzed retrospectively. Total 11 patients in 11 renal unite age 4 15 years (average 8.4 ?years), all patient were male. After admission in the department of urology all the patient were evaluated by history, clinical examination and investigations. Basic workup of these patients includes renal function, urine culture and intravenous urogram. Those patients having growth of organism in urine c/s procedure postponed and antibiotic therapy as per els given. After proper treatment of infection PCNL was performed. One patient had positive urine culture. Procedure performed under general anaesthesia. Initial ureteric catheterization done in cystoscopic position then change the position to prone position. Initial puncture Vol. 16, Ne. 2, July 2012 Journal of Surgical Sciences was made in desire calyx underftuoroscopic guidance. Tract was dilated by alken's metallic telescopic dilator. Location of stone Partial staghorn calculus Pelvis stone Pelvis stone and inf.calyceal stone Upper calyceal stone Residual upper calyceal stone after open surgery Site of puncture Inferior calyceal puncture Upper calyceal puncture Mid calyceai puncture Single (fluroscope guided) : 3 cases : 3 cases : 2 cases : 2 cases : 1 • "7 . ( :2 :2 All patients underwent PCNL in single stage using adult instrument. In some cases sheath less 24 Fr Nephroscope and in some cases 10 Fr URS. Stone were fragmented by pneumatic lithotripter. Complete clearance of stone confirmed by fluoroscope and nephroscope. In 7 cases procedure ended with nephrostomy tube and JJ stent and in 4 cases procedure ended only JJ stent without nephrostomy tube. Nephrostomy tube removed after 24 hours and JJ stent removed after 21 days. After removing all -tubes, urine culture was done. IVU was done after 3 months. Every patient underwent metabolic evaluation. In some cases tract dilated upto 21 Fr and insome cases 24 Fr. Right renal stone Puncture ~ tract dilation Endoscopic view of stone Complete clearance of stone AfterPCNL

Percutaneous Nephrolithotomy (PCNL) for Management of Renal Stone in Pediatric Patient- Single Center Experience