INTRODUCTION: We present our experience with percutaneous nephrolithotomy (PCNL) for renal calculi in children younger than 5 years old and determine its safety and efficacy.

 MATERIALS AND METHODS: Twenty patients (13 boys and 7 girls; 4 with bilateral renal stones) with a mean age of3.1 years (5 months to 5 years) underwent 26 PCNL procedures on 24 renal units between Aug 2003 and July 2008. All procedures were performed in prone position after retrograde catheterization with a 4Fr or 5Fr ureteral catheter. Nephrostomyt ract dilated up to 26 Fr then 24 Fr rigid nephroscope was used and stones fragmentedw ith pneumatic, lithotripter. Variablesa ssessewd ere stones ize,location and type. Metabolic and anatomic factors, number of tract, stone free rate and ancillary procedure were also evaluated.

 RESULTS: Five patients (20%) had staghorn stones and 5 (20%) had multiple stones (more than 5). Two patients had undergone bilateral open surgery and 2 had a previous PCNL history. All of the patients managed only with one tract, two cases performed by ultrasonography guided punctures and for other patients by fluoroscopy guided punctures. The mean stone size was 33 mm (20-46 mm) and average operative time was 93.25 minutes. Stones were completely cleared in 79.16% of patients which increased to 91.67% after combining with adjunctive shockwave lithotripsy. Two patients (8.33%) required repeat PCNL for residual stones and 1 (4.11%) underwent transureterallithotripsy (TUL) for migrated residual stone to the ureter. The overall complication rate was 11.82% and mean hospital stay was 5.26 days.

 CONCLUSION: PCNL is a suitable alternative for complex, staghorn or resistant stones to ESWL. We demonstrated that even with use of adult-size device in very young children, complication rate was low, so PCNL is a safe method in this group of population.