Bilateral Single-session PCNL with Minimally Invasive Technique in Pediatric Nephrolithiasis

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Nephrolithiasis Management

Background:

• Pediatric nephrolithiasis requires effective treatment options.
• Minimally invasive techniques are increasingly important in pediatric surgery.
• Bilateral kidney stones present unique management challenges.

Purpose of the Study:

• To evaluate the outcomes of bilateral single-session percutaneous nephrolithotomy (PCNL) in children.
• To assess the efficacy and safety of minimally invasive PCNL techniques (miniPCNL and Microperc) in pediatric patients.
• To compare outcomes between different minimally invasive approaches for bilateral kidney stones.

Main Methods:

• A retrospective study of 45 pediatric patients (including 12 infants) undergoing bilateral single-session PCNL (miniPCNL and Microperc) from August 2015 to July 2021.
• Analysis of patient, stone, and operation-related characteristics.
• Comparison of stone-free rate (SFR) and complication rate (CR) using ANOVA and multivariate linear regression.

Main Results:

• The mean stone burden was 3.2 cm; mean operative time was 61.6 minutes, with a 93.3% SFR and 53.3% CR (mostly Clavien grade 1-2).
• Microperc technique was associated with less irrigation volume and shorter postoperative stay compared to miniPCNL.
• Stone burden was the only independent predictor for operative time and postoperative complications. Older age, higher BMI, and larger stone burden correlated with increased fluid volume.

Conclusions:

• Bilateral single-session PCNL with minimally invasive techniques demonstrates a favorable stone-free rate and acceptable complication rate in pediatric nephrolithiasis.
• The procedure is considered effective and safe for managing bilateral kidney stones in children.
• Microperc shows advantages in reduced irrigation volume and shorter hospital stay.