Mini versus standard percutaneous nephrolithotomy for treatment of pediatric renal stones: Is smaller enough?

• Published in: Journal of pediatric urology 2019-12, Vol.15 (6), p.664.e1-664.e6
• Main Authors: Mahmood, Sarwar Noori, Aziz, Bryar Othman, Toffeq, Hewa Mahmoud, Fakhraldin, Saman Salih
• Format: Article
• Language: English
• Subjects: Mini-PCNL; Pediatric; Pediatrics; Percutaneous nephrolithotomy; Percutaneous renal surgery; Urolithiasis; Urology
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2019.09.009

SummaryIntroductionMiniaturized percutaneous nephrolithotomy (PCNL) has gained increased popularity due to efforts in recent years to lower perioperative morbidity while maintaining a high stone-free rate (SFR). ObjectiveWe retrospectively assessed the outcomes of pediatric renal stones treated by mini-PCNL (MPCNL) versus standard PCNL (SPCNL). Study designWe performed a retrospective data analysis of 134 consecutive patients below the age of 17 years who underwent PCNL between January 2014 and July 2018. The patients were categorized into two treatment groups depending on tract size and instruments used. Seventy-five patients were treated with SPCNL using adult instruments via a 22–26 Fr tract, and 59 patients were treated with MPCNL using pediatric instruments via a 16–20 Fr tract. ResultsA total of 134 children (SPCNL = 75; MPCNL = 59) underwent PCNL and subsequent evaluation. Patient demographics and stone characteristics were comparable between the two groups. The mean stone size ranged from 1.9 ± 1.162 cm in the MPCNL group to 2.2 ± 1.424 cm in the SPCNL group, and the overall SFR was 89.5% in the MPCNL group and 94.7% in the SPCNL group. When comparing the common characteristics, no significant difference was found between the two surgical access regarding the mean operative duration, SFR, incidence of perioperative complications, and rate of bleeding requiring a blood transfusion. Conversely, the mean postoperative hemoglobin decrease was significantly lower in the MPCNL group relative to the SPCNL group, at 0.354 ± 0.299 g versus 0.568 ± 0.332 g, respectively ( P = 0.001). In addition, the mean duration of hospitalization was significantly lower in the MPCNL group compared to the SPCNL group, at 1.91 ± 1.154 days compared to 2.41 ± 1.14 days, respectively ( P = 0.014). DiscussionHerein, we report the first systematic review of the first center in the locality treating this cross-section of patients. Our review reveals that the use of these smaller instruments can deliver a strong safety profile while achieving good stone clearance. As an alternative to decreasing the perioperative morbidity associated with SPCNL, MPCNL can be conveniently used without affecting the outcomes of the procedure. It is a safe and feasible procedure for maximal clearance of stones and should comprise the treatment of choice—regardless of age—for experienced endourologists. ConclusionMPCNL represents a valuable way of treating simple and complex renal stones in children,