Mini-versus standard percutaneous nephrolithotomy in pediatric population: A randomized controlled trial

Area of Science:

• Pediatric Urology
• Nephrolithiasis Management
• Minimally Invasive Surgery

Background:

• Mini percutaneous nephrolithotomy (mPCNL) is increasingly used in adults for renal calculi, offering lower complication rates.
• Evidence for mPCNL's efficacy and safety in pediatric patients is limited.

Purpose of the Study:

• To compare mini PCNL (mPCNL) with standard PCNL (sPCNL) in children (<18 years).
• To evaluate safety, efficacy, and stone-free rates (SFR) of both procedures.

Main Methods:

• A randomized controlled trial involving 50 pediatric patients with renal calculi.
• Patients were divided into two groups: mPCNL (sheath size 16.5 Fr) and sPCNL (sheath size 26 Fr).
• Outcomes included SFR, hemoglobin drop, operative time, complications, pain, analgesia, nephrostomy site leak, and hospital stay.

Main Results:

• Stone-free rates were comparable: 88% for mPCNL vs. 92% for sPCNL.
• mPCNL showed significantly less hemoglobin drop (1.1 g/dL vs. 1.7 g/dL).
• mPCNL had lower complication rates (Grade I) but longer operative times; pain scores were also lower.

Conclusions:

• Mini PCNL is a safe and effective option for pediatric renal calculi, yielding equivalent stone clearance to standard PCNL.
• mPCNL demonstrates advantages in reduced blood loss and fewer complications, despite longer operative times.