Mini versus ultra-mini percutaneous nephrolithotomy in a paediatric population

Area of Science:

• Urology
• Minimally Invasive Surgery
• Pediatric Surgery

Background:

• Percutaneous nephrolithotomy (PCNL) is a key procedure for pediatric kidney stones.
• The choice of sheath size impacts procedure efficiency and outcomes.
• Ultra-mini PCNL utilizes smaller sheaths (e.g., 12 Fr) compared to mini PCNL (e.g., 16 Fr).

Purpose of the Study:

• To compare the outcomes of using a 12 Fr ultra-mini sheath versus a 16 Fr mini sheath for PCNL in pediatric patients.
• To evaluate stone-free rates, operative time, and complications in pediatric PCNL based on sheath size.

Main Methods:

• A prospective cohort study involving 80 pediatric patients undergoing PCNL over two years.
• Patients were divided into two groups based on sheath size: 12 Fr (ultra-mini) and 16 Fr (mini).
• Stone fragmentation was achieved using laser, and stone-free status was assessed at 3 months via X-ray.

Main Results:

• Stone-free rates were high and comparable in both groups (97.5% for 12 Fr vs. 95.0% for 16 Fr).
• The 16 Fr sheath group had a significantly shorter operative time (24.5 min) compared to the 12 Fr group (34.6 min).
• No significant differences in complications or hemoglobin decrease were observed between the groups.

Conclusions:

• Both 12 Fr ultra-mini and 16 Fr mini sheaths are effective for pediatric PCNL with similar stone clearance rates.
• The ultra-mini sheath (12 Fr) is associated with longer operative times but comparable safety and efficacy.
• Further research may explore optimizing operative time with ultra-mini PCNL techniques.