Preoperative evaluation of pediatric kidney stone prior to percutaneous nephrolithotomy: is computed tomography really n
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ORIGINAL PAPER
Preoperative evaluation of pediatric kidney stone prior to percutaneous nephrolithotomy: is computed tomography really necessary? Abdulkadir Tepeler • Ahmet Ali Sancaktutar • Mehmet Taskiran • Mesrur Selcuk Silay • Mehmet Nuri Bodakci • Tolga Akman • Orhan Tanriverdi Berkan Resorlu • Omer Faruk Bozkurt • Abdullah Armagan • Kemal Sarica
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Received: 5 March 2013 / Accepted: 17 July 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract The objective of the study was to investigate the precise role of computed tomography (CT) in preoperative radiologic evaluation and surgical planning of kidney stone in children prior to percutaneous nephrolithotomy (PNL). A total of 113 pediatric patients (aged B18 years) undergoing PNL for renal stone(s) in three referral hospitals between March 2010 and August 2012 were retrospectively evaluated. Depending on the preoperative radiologic evaluation, patients were divided into two groups. Those evaluated with CT were classified as group-1 (n = 50) and the remaining cases undergoing intravenous urography (IVU) examination were classified as group-2 (n = 63). Patient- and procedure-related variables and perioperative measures were compared between A. Tepeler (&) M. S. Silay T. Akman A. Armagan Department of Urology, Faculty of Medicine, Bezmialem Vakif University, 34093 Fatih, Istanbul, Turkey e-mail: [email protected] A. A. Sancaktutar M. N. Bodakci Department of Urology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey M. Taskiran O. Tanriverdi Department of Urology, Sisli Etfal Teaching and Research Hospital, Istanbul, Turkey B. Resorlu Department of Urology, Faculty of Medicine, Onsekiz Mart University, Canakkale, Turkey O. F. Bozkurt Department of Urology, Kecioren Teaching and Research Hospital, Ankara, Turkey K. Sarica Department of Urology, Kartal Lutfu Kirdar Research and Teaching Hospital, Istanbul, Turkey
the groups. The mean age, stone size and localization were similar in both groups (p = 0.07, p = 0.57, p = 0.6, respectively). Although the postoperative hemoglobin drop was found to be significantly higher in group-2 (1.5 ± 1.3 vs. 0.9 ± 0.6 g/dL, p = 0.005), the mean operation time, fluoroscopic screening time, access number, overall success and complication rates were comparable (p = 0.06, p = 0.94, p = 0.75, p = 041, and p = 0.41, respectively). However, the mean hospitalization time was significantly prolonged in group-2 than in group-1 (p = 0.03). Our findings clearly demonstrate that, despite the key role of preoperative CT in particular patients with anatomically abnormal kidneys, IVU is a valuable alternative imaging modality with comparable radiation doses in children. Keywords Kidney stone Percutaneous nephrolithotomy Children Radiologic workup Computed tomography Radiation exposure
Introduction Recent studies have demonstrated an increase in the incidence of urolithiasis in children [1–3]. A 4 %/year increase rate in the incidence of nephrolithiasis in these cases throughout a 25-year period in a geographic
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